Abstract 13947: Right Ventricular Deformation and Function: The Clue to Diagnose Acute Rejection?

Abstract

Right ventricular (RV) function monitoring is mandatory in heart transplantation (HTx). Acute Rejection (AR) in HTx is currently diagnosed by endomyocardial biopsy (EB). We sought to evaluate right ventricular (RV) function to diagnose AR.

Methods:We included 21consecutive HTx patients since 2009.11 echocardiograms/patient were done the same day of EB. For RV systolic assessment, tricuspid annular systolic excursion (TAPSE), RV fractional area change (FAC), TDI systolic (S) velocity and Tei index were measured. RV longitudinal strain was measured in 6 RV segments (basal, mid and apical).

Results: We analized 1296 segments. According to ISHLT: 107 biopsies had grade 0R AR, 30 1R, 4 had 2R and 1 3R.Relationship among RV parameters and AR is shown in table.ROC curves showed that a lateral LongS cutoff value of -20% was associated with a sensitivity of 70%, specificity 62% and predictive negative value 84% to exclude AR. Only RV lateral LongS was independently associated with AR(RR 2.6 [CI 95% 1.3-5.4 p 0.01]). Additionaly, we found that classic and strain parameters improved after 1 year follow-up: TAPSE(10.9±2.4 vs 17.4±3.4,p 0.001), TDI S cm/sg (9.5 2.5 vs 11.5±2.7,p 0.016), Tei Index ( 0.77±0.32 vs0.61±0.32,p 0.004), RV global strain(-15.9±3.7 vs -20.4±4.7,p 0.04), RV lateral strain (-17.3±5.1 vs -26.2±6.6,p 0.001).

Conclusion: 2D strain is a useful tool in the detection of AR. RV Lateral strain is the best parameter for its diagnosis. We may use it as a screening tool to identify whose patients are going to require EB to confirm it.Most patients improve RV function 1 year after HTx. New techniques such as RV longitudinal strain offer an alternative to evaluate RV normalization.