Abstract 14733: Tissue Doppler and Strain Imaging can Improve Evaluation of the Therapeutic Relevance of Biopsy Proven Heart Transplant Acute Rejections
Background The ISHLT scoring system is the basis of therapeutic decisions for heart transplant acute rejection (AR). However, whereas the severity of cardiac dysfunction detectable by echocardiography (ECHO) during AR is not always reflected by that scoring system, the low sensitivity of conventional ECHO often impedes detection of mild AR. Myocardial wall motion and deformation analysis, easy to perform by Tissue Doppler (TD) and strain imaging, reveal myocardial dysfunction undetectable by simple ECHO. We compared the lesions found in endomyocardial biopsies (EMBs) with functional data provided by TD and strain imaging.
Methods We selected for evaluation all ECHO parameters, including TD and 2D strain data on left ventricular (LV) wall motion and myocardial deformation, collected since 1/2006 before each EMB. Alteration of LV function was tested for relationship to the morphologic grade of AR.
Results Of 214 cellular ARs detected in EMBs of 152 patients, 165 (77.1%) were mild (1 R), 45 (21%) moderate (2 R) and 4 (1.9%) severe (3 R). Of all patients with AR grade 1 R, 35 (21.2%) were symptomatic but only 4 showed LV dysfunction detectable by simple ECHO. These 35 symptomatic ARs plus 15 other asymptomatic mild cellular ARs were accompanied by reduction of ≥ 15% in peak systolic wall motion velocity (Sm) and systolic strain rate (SSr) and in the EMBs of all these patients there were also signs of humoral AR. Sm and SSr reduction were reversible in 98% of these patients after therapy. Among all ARs with TD and/or 2D strain parameter alterations, only 47.4% were moderate or severe (2 or 3 R); the other 52.6% were mild (1 R). During symptomatic AR grade 1 R, both Sm and SSr changes were equivalent to those found during moderate and severe cellular ARs (2 and 3 R). Of 14 patients with recurrent ARs associated with Sm and SSr changes, 10 (71.4%) developed coronary stenoses during the next 15 ± 8 months after the first ARs.
Conclusions TD and strain imaging can reveal functionally and prognostically relevant ARs which are underestimated by morphologic grading. The high prevalence of histologically mild ARs accompanied by myocardial dysfunction and the reversibility of LV dysfunction after therapy suggests the usefulness of TD and strain imaging for improvement of therapeutic decisions.
- © 2012 by American Heart Association, Inc.