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Ji X, Zhang J, Xie Y, Wang W, Zhang Y, Xie M, Zhang L. Speckle-Tracking Echocardiography in Right Ventricular Function of Clinically Well Patients with Heart Transplantation. Diagnostics (Basel) 2024; 14:1305. [PMID: 38928720 PMCID: PMC11203351 DOI: 10.3390/diagnostics14121305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Heart transplantation (HT) is the mainstream therapy for end-stage heart disease. However, the cardiac graft function can be affected by several factors. It is important to monitor HT patients for signs of graft dysfunction. Transthoracic echocardiography is a simple, first-line, and non-invasive method for the assessment of cardiac function. The emerging speckle-tracking echocardiography (STE) could quickly and easily provide additive information over traditional echocardiography. STE longitudinal deformation parameters are markers of early impairment of ventricular function. Although once called the "forgotten ventricle", right ventricular (RV) assessment has gained attention in recent years. This review highlights the potentially favorable role of STE in assessing RV systolic function in clinically well HT patients.
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Affiliation(s)
- Xiang Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Junmin Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuji Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenyuan Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yiwei Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Pergola V, Mattesi G, Cozza E, Pradegan N, Tessari C, Dellino CM, Savo MT, Amato F, Cecere A, Perazzolo Marra M, Tona F, Guaricci AI, De Conti G, Gerosa G, Iliceto S, Motta R. New Non-Invasive Imaging Technologies in Cardiac Transplant Follow-Up: Acquired Evidence and Future Options. Diagnostics (Basel) 2023; 13:2818. [PMID: 37685356 PMCID: PMC10487200 DOI: 10.3390/diagnostics13172818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Heart transplantation (HT) is the established treatment for end-stage heart failure, significantly enhancing patients' survival and quality of life. To ensure optimal outcomes, the routine monitoring of HT recipients is paramount. While existing guidelines offer guidance on a blend of invasive and non-invasive imaging techniques, certain aspects such as the timing of echocardiographic assessments and the role of echocardiography or cardiac magnetic resonance (CMR) as alternatives to serial endomyocardial biopsies (EMBs) for rejection monitoring are not specifically outlined in the guidelines. Furthermore, invasive coronary angiography (ICA) is still recommended as the gold-standard procedure, usually performed one year after surgery and every two years thereafter. This review focuses on recent advancements in non-invasive and contrast-saving imaging techniques that have been investigated for HT patients. The aim of the manuscript is to identify imaging modalities that may potentially replace or reduce the need for invasive procedures such as ICA and EMB, considering their respective advantages and disadvantages. We emphasize the transformative potential of non-invasive techniques in elevating patient care. Advanced echocardiography techniques, including strain imaging and tissue Doppler imaging, offer enhanced insights into cardiac function, while CMR, through its multi-parametric mapping techniques, such as T1 and T2 mapping, allows for the non-invasive assessment of inflammation and tissue characterization. Cardiac computed tomography (CCT), particularly with its ability to evaluate coronary artery disease and assess graft vasculopathy, emerges as an integral tool in the follow-up of HT patients. Recent studies have highlighted the potential of nuclear myocardial perfusion imaging, including myocardial blood flow quantification, as a non-invasive method for diagnosing and prognosticating CAV. These advanced imaging approaches hold promise in mitigating the need for invasive procedures like ICA and EMB when evaluating the benefits and limitations of each modality.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Giulia Mattesi
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Elena Cozza
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Carlo Maria Dellino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Maria Teresa Savo
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Filippo Amato
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Annagrazia Cecere
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital “Policlinico” of Bari, 70124 Bari, Italy;
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
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Sade LE, Colak A, Duzgun SA, Hazırolan T, Sezgin A, Donal E, Butcher SC, Özdemir H, Pirat B, Eroglu S, Muderrisoglu H. Approach to optimal assessment of right ventricular remodelling in heart transplant recipients: insights from myocardial work index, T1 mapping, and endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 2023; 24:354-363. [PMID: 35666833 DOI: 10.1093/ehjci/jeac108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/12/2022] [Accepted: 05/21/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients. METHODS AND RESULTS Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 ± 8.7%) and MWI (403.2 ± 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69-0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage. CONCLUSION Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage.
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Affiliation(s)
- Leyla Elif Sade
- Cardiology Department, University of Baskent, 06490 Ankara, Turkey.,UPMC Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, Ste E354.2, Pittsburgh, PA 15213, USA
| | - Ayse Colak
- Cardiology Department, University of Baskent, 06490 Ankara, Turkey
| | | | - Tuncay Hazırolan
- Radiology Department, University of Hacettepe, 06100 Ankara, Turkey
| | - Atilla Sezgin
- Cardiothoracic Surgery Department, University of Baskent, 06490 Ankara, Turkey
| | - Erwan Donal
- Cardiology Department, University of Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Steele C Butcher
- Cardiology Department, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Handan Özdemir
- Pathology Department, University of Baskent, 06490 Ankara, Turkey
| | - Bahar Pirat
- Cardiology Department, University of Baskent, 06490 Ankara, Turkey
| | - Serpil Eroglu
- Cardiology Department, University of Baskent, 06490 Ankara, Turkey
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Yang Y, Li T, Zhou X, Tan Z, Chen R, Xiao Z, Li X, Luo W, Xu H, Ye W, Liu E, Wu Z, Wu M, Liu H. Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in asymptomatic heart-transplanted patients. Eur Radiol 2022:10.1007/s00330-022-09358-2. [PMID: 36571606 DOI: 10.1007/s00330-022-09358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 09/22/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe the dynamic changes in cardiac deformation and tissue characteristics using cardiac magnetic resonance (CMR) in asymptomatic patients during 12 months after heart transplantation (HT). METHODS From April 2020 to January 2021, 21 consecutive HT patients without clinical symptoms were included in this prospective study. Multiparametric CMR was performed at 3, 6, and 12 months after HT. Twenty-five healthy volunteers served as controls. RESULTS During follow-up, a decline in left ventricular (LV) global radial strain (GRS) (p = 0.020) and right ventricular (RV) global longitudinal strain (GLS) (p < 0.001) and an increase in post-contrast T1 (p = 0.024) and T2 (p < 0.001) in asymptomatic HT patients occurred at 3 months, which normalized at 6 months postoperatively, compared with those in healthy controls. A decline in LVGLS (p < 0.001) and LV global circumferential strain (GCS) (p < 0.001) and an increase in native T1 (p < 0.001), T2 (p < 0.001), and extracellular volume (ECV) (p < 0.001) occurred at 3 months. Although most parameters improved gradually, LVGLS, native T1, and ECV remained abnormal compared with those in healthy controls at 12 months; only T2 and LVGCS were normalized at 6 months and 12 months, respectively. ECV was significantly correlated with LVGLS, LVGCS, and LVGRS. CONCLUSION Cardiac deformation and tissue characteristics were abnormal early after HT, although the patients were clinically asymptomatic. The dynamic changes in CMR characteristics demonstrate a gradual recovery of myocardial injury associated with transplantation during the first 12 months after HT. KEY POINTS • Multiparametric CMR can detect the dynamic changes of transplantation-associated myocardial injury. • Post-contrast T1, T2, LVGRS, and RVGLS values are normalized at 6 months after HT. • Native T1, ECV, and LVGLS values remain abnormal compared with those in healthy controls at 12 months after HT.
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Affiliation(s)
- Yuelong Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Tingyu Li
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaobing Zhou
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China
| | - Zekun Tan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Rui Chen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zebin Xiao
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaodan Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Wei Luo
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Huanwen Xu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Entao Liu
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhigang Wu
- Philips Healthcare China, Shenzhen, 518000, China
| | - Min Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Hui Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China. .,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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da Costa RCPL, Rodrigues ACT, Vieira MLC, Fischer CH, Monaco CG, Filho EBL, Bacal F, Caixeta A, Morhy SS. Evaluation of the myocardial deformation in the diagnosis of rejection after heart transplantation. Front Cardiovasc Med 2022; 9:991016. [PMID: 36312230 PMCID: PMC9606419 DOI: 10.3389/fcvm.2022.991016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Heart transplantation represents main therapy for end-stage heart failure. However, survival after transplantation is limited by development of graft rejection. Endomyocardial biopsy, an invasive and expensive procedure, is gold standard technique for diagnosis of rejection. Most of biopsy complications are observed using echocardiography. Novel echocardiographic techniques, such as myocardial strain and three-dimensional reconstruction, can be useful in heart transplant patients. Purpose To evaluate ventricular strain in heart transplant patients and association with rejection, cellular or humoral, as well as two- and three-dimensional echocardiographic parameters. Methods Cohort of patients from heart transplant program taken to echocardiography after endomyocardial biopsy, from December 2017 to January 2020. Ventricular strain and three-dimensional left ventricle parameters were studied. Rejection results were retrieved from medical record. Qualitative variables were expressed by absolute frequency and percentages, while continuous variables by means and standard deviations. Association between rejection and variables of interest was measured by odds ratio and confidence interval of 95%, with p-value < 0.05. Results 123 post-endomyocardial biopsy echocardiographic exams were performed in 54 patients. Eighteen exams were excluded, lasting 105 exams to be evaluated for conventional and advanced echocardiographic parameters. Male patients were 60.4%. Prevalence of cellular rejection was 8.6%, humoral rejection 12.4%, and rejection of any type 20%. There was no association between right ventricular strain and rejection, whether cellular (p = 0.118 and p = 0.227 for septum and free wall, respectively), humoral (p = 0.845 and p = 0.283, respectively), or of any type (0.504 and 0.446). There was no correlation between rejection and left ventricle global longitudinal strain, three-dimensional ejection fraction or desynchrony index. Conventional parameters associated to rejection were left ventricle posterior wall thickness [OR 1.660 (1.163; 2.370), p = 0.005] and left ventricle mass index [OR 1.027 (1.011; 1.139), p = 0.001]. Left ventricle posterior wall thickness remained significant after analysis of cellular and humoral rejection separately [OR 1.825 (1.097; 3.036), p = 0.021 and OR 1.650 (1.028; 2.648), p = 0.038, respectively]. Conclusions There was no association between ventricular strain, three-dimensional left ventricular ejection fraction and the desynchrony index and rejection, cellular or humoral. Evidence of association of graft rejection with left ventricle posterior wall thickness and left ventricle mass index was observed.
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Chamberlain R, Edwards NFA, Scalia GM, Chan J. Novel left and right ventricular strain analysis to detect subclinical myocardial dysfunction in cardiac allograft rejection. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1077-1088. [PMID: 34936051 DOI: 10.1007/s10554-021-02486-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Early detection of acute cellular rejection (ACR) by echocardiography shows potential clinical benefit as ACR remains a significant contributor to morbidity and mortality. This retrospective, longitudinal study sought to investigate the use of novel left (LV) and right ventricular (RV) strain analysis to detect biopsy proven ACR. 46 heart transplant patients (Mean age 46 ± 16 years) with biopsy proven ACR were grouped according to biopsy results: 1R-ACR (n = 36) and 2R-ACR (n = 10). Serial two-dimensional transthoracic echocardiography with strain analysis was performed. Echocardiographic parameters were serially measured: (1) rejection free period (0R-ACR); (2) pre-ACR period (pre-ACR); (3) during ACR (1R-ACR or 2R-ACR) and (4) post-ACR (Post-ACR). Significant reductions for LV Global Longitudinal Strain (LV GLS) and LV Early diastolic Strain rate (LV ESr) were observed between 0R-ACR and pre-ACR (LV GLS 0R-ACR: 17.3% vs Pre-2R ACR: 15.4%, p = 0.016; LV ESr 0R-ACR: 1.00/s vs Pre-2R ACR: 0.74/s, p = 0.007) with LV ESr demonstrating the highest sensitivity (92%) and specificity (81%) to predict ACR. LV ESr and the E/LV ESr ratio were significantly different (p = 0.0001; p = 0.016) during pre-1R ACR period vs 0R whereas LV GLS showed no significant differences for grade 1R-ACR. Diastolic mechanical dispersion showed significant increases in dispersion during ACR for the 1R-ACR group and early significant increases pre-2R ACR. Systolic and diastolic RV strain parameters showed a similar trend for both ACR groups. Systolic and diastolic strain parameters can detect myocardial dysfunction before biopsy confirmed 2R-ACR. Early diastolic strain rate parameters are most sensitive detecting subclinical myocardial dysfunction pre-ACR. Novel strain parameters are potentially useful clinical tool for prediction of early ACR in heart transplant.
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Affiliation(s)
- Robert Chamberlain
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Natalie F A Edwards
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Chamberlain R, Edwards NF, Doyle SN, Wong YW, Scalia GM, Sabapathy S, Chan J. Prognostic Value of Left and right ventricular deformation strain analysis on Acute Cellular rejection in Heart Transplant recipients: A 6-year outcome study. Int J Cardiovasc Imaging 2022; 38:2271-2281. [PMID: 36434347 PMCID: PMC9700648 DOI: 10.1007/s10554-022-02586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Two-dimensional (2D) strain analysis is a sensitive method for detecting myocardial dysfunction in acute cellular rejection (ACR) from post-transplant complications. This study aims to evaluate the utility of novel left (LV) and right ventricular (RV) strain parameters for prognostic risk stratification associated with ACR burden at 1-year post transplantation. METHODS 128 Heart transplant patients, assessed between 2012 and 2018, underwent transthoracic echocardiography and endomyocardial biopsy. 2D strain analysis was performed and history of rejection burden was assessed and grouped according to ACR burden at 1-year post transplantation. The primary endpoint was all-cause mortality at 6-years follow up. RESULTS 21 patients met primary the endpoint. Multivariate analysis of 6-year all-cause mortality showed LV global longitudinal strain (LV GLS) (Hazard Ratio [HR] = 1.21, CI = 1.06-1.49), LV early diastolic strain rate (LV ESr) (HR = 1.31, CI = 1.12-1.54), RV GLS (HR = 1.12, CI = 1.02-1.25) and RV ESr (HR = 1.26, CI = 1.12-1.47) were significant predictors of outcome. Univariate analysis also showed LV GLS, LV ESr, RV GLS and RV ESr were significant predictors of outcome. Optimal cut-off for predicting 6-year mortality for LV GLS by receive operator characteristic was 15.5% (sensitivity: 92%, specificity: 79%). Significant reductions (p < 0.05) in LV GLS, RV GLS and LV and RV ESr between rejection groups were seen. CONCLUSIONS Non-invasive LV and RV strain parameters are predictors of mortality in post-transplant patient with ACR. LV GLS and LV ESr are superior to other strain and conventional echo parameters.
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Affiliation(s)
- Robert Chamberlain
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Natalie F.A. Edwards
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Samantha N. Doyle
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Yee Weng Wong
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, University of Queensland, Brisbane, Australia
| | - Gregory M. Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, University of Queensland, Brisbane, Australia
| | - Surendran Sabapathy
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia ,The Prince Charles Hospital, Department of Cardiology, Rode Road, 4032 Chermside, Queensland Australia
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Husain N, Watanabe K, Berhane H, Gupta A, Markl M, Rigsby CK, Robinson JD. Multi-parametric cardiovascular magnetic resonance with regadenoson stress perfusion is safe following pediatric heart transplantation and identifies history of rejection and cardiac allograft vasculopathy. J Cardiovasc Magn Reson 2021; 23:135. [PMID: 34809650 PMCID: PMC8607604 DOI: 10.1186/s12968-021-00803-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The progressive risk of graft failure in pediatric heart transplantation (PHT) necessitates close surveillance for rejection and coronary allograft vasculopathy (CAV). The current gold standard of surveillance via invasive coronary angiography is costly, imperfect and associated with complications. Our goal was to assess the safety and feasibility of a comprehensive multi-parametric CMR protocol with regadenoson stress perfusion in PHT and evaluate for associations with clinical history of rejection and CAV. METHODS We performed a retrospective review of 26 PHT recipients who underwent stress CMR with tissue characterization and compared with 18 age-matched healthy controls. CMR protocol included myocardial T2, T1 and extracellular volume (ECV) mapping, late gadolinium enhancement (LGE), qualitative and semi-quantitative stress perfusion (myocardial perfusion reserve index; MPRI) and strain imaging. Clinical, demographics, rejection score and CAV history were recorded and correlated with CMR parameters. RESULTS Mean age at transplant was 9.3 ± 5.5 years and median duration since transplant was 5.1 years (IQR 7.5 years). One patient had active rejection at the time of CMR, 11/26 (42%) had CAV 1 and 1/26 (4%) had CAV 2. Biventricular volumes were smaller and cardiac output higher in PHT vs. healthy controls. Global T1 (1053 ± 42 ms vs 986 ± 42 ms; p < 0.001) and ECV (26.5 ± 4.0% vs 24.0 ± 2.7%; p = 0.017) were higher in PHT compared to helathy controls. Significant relationships between changes in myocardial tissue structure and function were noted in PHT: increased T2 correlated with reduced LVEF (r = - 0.57, p = 0.005), reduced global circumferential strain (r = - 0.73, p < 0.001) and reduced global longitudinal strain (r = - 0.49, p = 0.03). In addition, significant relationships were noted between higher rejection score and global T1 (r = 0.38, p = 0.05), T2 (r = 0.39, p = 0.058) and ECV (r = 0.68, p < 0.001). The presence of even low-grade CAV was associated with higher global T1, global ECV and maximum segmental T2. No major side effects were noted with stress testing. MPRI was analyzed with good interobserver reliability and was lower in PHT compared to healthy controls (0.69 ± - 0.21 vs 0.94 ± 0.22; p < 0.001). CONCLUSION In a PHT population with low incidence of rejection or high-grade CAV, CMR demonstrates important differences in myocardial structure, function and perfusion compared to age-matched healthy controls. Regadenoson stress perfusion CMR could be safely and reliably performed. Increasing T2 values were associated with worsening left ventricular function and increasing T1/ECV values were associated with rejection history and low-grade CAV. These findings warrant larger prospective studies to further define the role of CMR in PHT graft surveillance.
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Affiliation(s)
- Nazia Husain
- Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Kae Watanabe
- Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Haben Berhane
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA
| | - Aditi Gupta
- Lincoln Medical and Mental Health Center, Bronx, NY USA
| | - Michael Markl
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Cynthia K. Rigsby
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Imaging, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - Joshua D. Robinson
- Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
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9
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Perez-Fernandez OM, Medina HM, Lopez M, Barrera M, Martinez A, Benavides J, Duran JC, Salazar G, Manrique FT. Global longitudinal strain in heart transplantation recipients using different vendors: reliability and validity in a tertiary hospital in Colombia. Int J Cardiovasc Imaging 2021; 38:279-287. [PMID: 34487311 DOI: 10.1007/s10554-021-02398-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/30/2021] [Indexed: 12/27/2022]
Abstract
Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.
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Affiliation(s)
- Oscar Mauricio Perez-Fernandez
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.
| | - Hector M Medina
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Mónica Lopez
- Research Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.,Cardiology and Heart Transplantation Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Madeleine Barrera
- Cardiology Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Azucena Martinez
- Cardiology Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Jhonattan Benavides
- Cardiology Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Juan C Duran
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Gabriel Salazar
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Frida Tatiana Manrique
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.
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10
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Impaired left atrial function in clinically well heart transplant patients. Int J Cardiovasc Imaging 2021; 37:1937-1945. [PMID: 33620609 DOI: 10.1007/s10554-021-02177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
Left atrial (LA) enlargement is present in the majority of adult heart transplant (HT) recipients. We used speckle-tracking echocardiography to investigate whether LA phasic function in HT patients is altered and explored its relationship to HT-related clinical variables. This study evaluated LA function in 112 clinically well HT patients and 40 healthy controls. Clinical data included recipient age at HT, donor age, ischemia time, left ventricular function, and biochemical indicators. Atrial deformation and volume indices were measured with two-dimensional and three-dimensional speckle-tracking echocardiography, respectively. Components of phasic atrial function were calculated and correlations to clinical variables were explored. Compared with controls, HT patients had worse LA reservoir, conduit, and pump function. LA reservoir function of the bicaval group was better than the biatrial group, but differences did not persist after adjustment for potential confounders. Among patients with HT, those with lower LAS-peak had an older recipient age, larger LA volume, as well as worse left ventricular systolic function than those patients with higher LAS-peak. However, E/e', biochemical indicators and donor-related information were similar across the quartiles of LA function. In HT cohort, we observed impairment in all phases of LA function, and LA reservoir function was decreased independent of surgical technique. LAS-peak was associated with worse left ventricular systolic function, which suggested that LA function may play an important role in HT patients.
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11
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Abstract
Heart transplantation (HTx) remains the optimal treatment for selected patients with end-stage advanced heart failure. However, survival is limited early by acute rejection and long term by cardiac allograft vasculopathy (CAV). Even though the diagnosis of rejection is based on histology, cardiac imaging provides a pivotal role for early detection and severity assessment of these hazards. The present review focuses on the use and reliability of different invasive and non-invasive imaging modalities to detect and monitor CAV and rejection after HTx. Coronary angiography remains the corner stone in routine CAV surveillance. However, angiograms are invasive and underestimates the CAV severity especially in the early phase. Intravascular ultrasound and optical coherence tomography are invasive methods for intracoronary imaging that detects early CAV lesions not evident by angiograms. Non-invasive imaging can be divided into myocardial perfusion imaging, anatomical/structural imaging and myocardial functional imaging. The different non-invasive imaging modalities all provide clinical and prognostic information and may have a gatekeeper role for invasive monitoring. Acute rejection and CAV are still significant clinical problems after HTx. No imaging modality provides complete information on graft function, coronary anatomy and myocardial perfusion. However, a combination of invasive and non-invasive modalities at different stages following HTx should be considered for optimal personalized surveillance and risk stratification.
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Affiliation(s)
| | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
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12
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Lv Q, Li M, Li H, Wu C, Dong N, Li Y, Zhang L, Xie M. Assessment of biventricular function by three-dimensional speckle-tracking echocardiography in clinically well pediatric heart transplantation patients. Echocardiography 2020; 37:2107-2115. [PMID: 33078446 DOI: 10.1111/echo.14893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The biventricular function plays an important role in the prognosis of pediatric heart transplantation (HTx) patients. Therefore, in this study, we aimed to evaluate the biventricular function of pediatric HTx patients by three-dimensional (3D) speckle-tracking echocardiography (3D-STE). METHODS We enrolled 30 clinically well pediatric HTx patients and 30 healthy controls with a similar distribution of sex and age to the HTx. All participants underwent comprehensive two-dimensional (2D) and 3D echocardiography. Left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS), left and right ventricular ejection fraction (LVEF and RVEF, respectively), and right ventricular free wall longitudinal strain (RV FWLS) were acquired by 3D-STE. Moreover, the correlations between strains and clinical data were explored. RESULTS Compared with controls, LV GLS was decreased in pediatric HTx patients (P < .05), while LV GCS and LVEF showed no difference. LV GLS showed a weak correlation with cold ischemic time in HTx group (r = 0.396, P < .05). Meanwhile, RVEF and RV FWLS were significantly lower in the HTx group (P < .05). In the HTx group, RV FWLS showed a weak correlation with the preoperative mean pulmonary artery pressure (r = 0.420, P < .05) and postoperative pulmonary artery systolic pressure (r = 0.465, P < .05). CONCLUSION The 3D-biventricular mechanical functions were decreased in clinically well pediatric HTx patients. The provided characteristics and appropriate normal values of biventricular mechanical functions can be the basis in subsequent studies in the pediatric HTx patients.
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Affiliation(s)
- Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Meng Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - He Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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13
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Ran H, Zhang PY, Wan LL, Ma XW, Dong J. Heart transplantation ten-year follow-ups: Deformation differentiation comparison of myocardial performance in left ventricle and right ventricle. Clin Physiol Funct Imaging 2020; 40:415-422. [PMID: 32853425 DOI: 10.1111/cpf.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 06/01/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We try to investigate whether the values of three-dimensional principal longitudinal strain present differently between the left and right ventricles in patients with long-time follow-ups after heart transplantation (HTx). METHODS AND RESULTS Transthoracic echocardiography with three-dimensional speckle tracking was performed at one-, five- and ten-year follow-ups in 62 "healthy" HTx patients together with routine echocardiographic evaluation in 32 control group (CG) individuals. Longitudinal strain was applied in all subjects assessing without myocardium wall motion abnormality. Firstly, left ventricular ejection fraction preserved in HTx and had no significant difference in comparison with the controls (p > .05). 3D measurement showed obvious reduction in global (%: CG: -20.5 ± 3.5 vs. HT1y: -13.7 ± 4.6, HT5y: -14.4 ± 4.5, HT10y: -14.6 ± 4.7. p < .01) and horizontal segmental (basal, mid, apical, CG vs. HTx: all p < .01) strain values of the left compared HTx with control subjects. Secondly, tissue Doppler imaging s' velocity and tricuspid annular plane systolic excursion reduced in HTx as compared to the controls in right ventricle (p < .01). Longitudinal strain presented a more distinctive reduction in global (%: CG: -24.5 ± 4.6 vs. HT1y:-14.8 ± 7.5, HT5y: -15.5 ± 6.4, HT10y: -15.9 ± 6.8. p < .01) and horizontal segmental (basal, mid, apical, CG vs. HTx: all p < .01) average values of the right compared HTx with control subjects. Thirdly, there weren't any significant changes between one-, five- and ten-year of all the values with HTx inter-group comparison in both the left and right ventricles (p > .05). Fourthly, the global and segmental strain of the right ventricle decreased more than that of the left ventricle in all HTx groups, with the global decreased differentiation rates of 7%, 7%, 6%, respectively. CONCLUSIONS Compared HTx with control subjects in both ventricles, conventional evaluation showed preserved or decreased functions in the left and right separately. Myocardial function evaluating by 3D longitudinal strain reduced after HTx, but the deformation of the right ventricle reduced more than those of the left ventricle. Additionally, 3D strain values almost remained with stable decreased differentiation rates during the long-time follow-ups.
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Affiliation(s)
- Hong Ran
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ping-Yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lin-Lin Wan
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Wu Ma
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Dong
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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14
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Parthiban A, Jani V, Zhang J, Li L, Craft M, Barnes A, Ballweg JA, Schuster A, Danford DA, Kutty S. Altered Biatrial Phasic Function after Heart Transplantation in Children. J Am Soc Echocardiogr 2020; 33:1132-1140.e2. [PMID: 32653298 DOI: 10.1016/j.echo.2020.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE We used two-dimensional echocardiographic speckle-tracking to investigate whether left and right atrial (LA and RA) phasic function in pediatric heart transplantation (HT) patients is altered and explored the relationship to HT-related clinical variables. METHODS Eighty-six subjects (36 HT and 50 normal children) were prospectively enrolled in two centers. Clinical data included age at HT, bypass time, ischemia time, donor age, and incidence of rejection. Atrial deformation indices including strain and strain rates (SRs) were measured using two-dimensional echocardiographic speckle-tracking. Components of phasic atrial function-reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) were calculated. Comparisons with controls were made using t test or Kruskal-Wallis test, and correlations to clinical variables were explored. RESULTS The mean age and body surface area of HT subjects were 10.2 ± 6.2 years and 1.2 ± 0.6 m2, respectively. The mean heart rates were higher in HT (96 ± 18 vs 88 ± 21 in controls). There were reductions in RA and LA reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) function in HT compared with controls. There was no relationship of LA and RA deformation indices with mean age at HT, bypass time, or ischemia time. The LA εcd correlated weakly with donor age (r = -0.49, P = .04) and RA SRr, and SRcd showed association with duration of HT (P < .05). Nineteen HT recipients had follow-up studies 0.24 ± 0.18 years after the first examination, and deformational indices were not significantly changed. CONCLUSIONS Atrial strain determination is feasible in pediatric HT recipients and demonstrates disruption of reservoir, conduit, and booster function of both atria in this population; we speculate this may be a consequence of ventricular diastolic dysfunction.
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Affiliation(s)
- Anitha Parthiban
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Vivek Jani
- The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jin Zhang
- The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ling Li
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Mary Craft
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Aleissa Barnes
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Jean A Ballweg
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - David A Danford
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Shelby Kutty
- The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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15
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Lv Q, Sun W, Wang J, Wu C, Li H, Shen X, Liang B, Dong N, Li Y, Zhang L, Xie M. Evaluation of Biventricular Functions in Transplanted Hearts Using 3-Dimensional Speckle-Tracking Echocardiography. J Am Heart Assoc 2020; 9:e015742. [PMID: 32370590 PMCID: PMC7660853 DOI: 10.1161/jaha.119.015742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The current study aims to validate the accuracy of 3-dimensional speckle-tracking echocardiography (3D-STE) in evaluating biventricular functions against the accuracy of cardiac magnetic resonance (CMR) and to explore the comprehensive characteristics and normal values for 3D-biventricular functions in transplanted hearts. Methods and Results A cohort of 35 heart transplant (HT) patients underwent both 3D echocardiography and CMR examination to validate the accuracy of 3D-STE in evaluating biventricular functions (Protocol 1). Then, 3D-STE derived biventricular functions were compared between 46 HT patients and 46 non-HT controls (Protocol 2). Protocol 1, validated that 3D-STE showed excellent accuracy in evaluating biventricular functions of transplanted hearts against CMR. Protocol 2, revealed lower (normal range) 3D-biventricular ejection fractions in HT patients than in controls (P<0.001). 3D-left ventricular global longitudinal strain, left ventricular-global circumferential strain, left ventricular-global radial strain, left ventricular-global performance index and right ventricular free-wall longitudinal strain were all lower in the HT patients than in healthy controls (P<0.001). Further, these strain values were all good for differentiating between groups (areas under the curve: 0.80-0.94, P<0.001). Moreover, left ventricular-lateral-wall radial displacement was higher and septal-wall radial displacement was lower in the HT group than in control group (P<0.001). Conclusions Compared with cardiac magnetic resonance, 3D-STE can evaluate biventricular functions of transplanted hearts accurately; 3D-biventricular mechanical functions are reduced even in clinically well HT patients. The provided characteristics and appropriate normal values of biventricular functions can be the basis for detection of ventricular dysfunction during follow-ups and further studies on transplanted hearts.
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Affiliation(s)
- Qing Lv
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Wei Sun
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Jing Wang
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Chun Wu
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - He Li
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Xuehua Shen
- Department of Radiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Bo Liang
- Department of Radiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Nianguo Dong
- Department of Cardiovascular Surgery Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yuman Li
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Li Zhang
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Mingxing Xie
- Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,Hubei Province Key Laboratory of Molecular Imaging Wuhan China
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16
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Cardiovascular magnetic resonance-derived myocardial strain in asymptomatic heart transplanted patients and its correlation with late gadolinium enhancement. Eur Radiol 2020; 30:4337-4346. [PMID: 32232791 DOI: 10.1007/s00330-020-06763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate whether cardiovascular magnetic resonance (CMR)-derived myocardial strains were abnormal in asymptomatic heart transplant (HT) patients with normal left ventricular ejection fraction (LVEF) and to detect the relationship between CMR-derived myocardial strain parameters and late gadolinium enhancement (LGE) in asymptomatic HT patients. METHODS A total of 72 HT patients and 35 healthy volunteers underwent 1.5-T MR scanning. The examination protocol included basic cine imaging and LGE. The deformation registration algorithm (DRA) and feature tracking (FT) software were used for the strain analyses. Myocardial strain measurements included left ventricular global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS), LV global radial strain (LVGRS) and right ventricular longitudinal strain (RVLS). RESULTS Compared with healthy volunteers, HT patients had significantly decreased DRA- and FT- derived myocardial strain measurements (all p < 0.05). There was a significant correlation and high reproducibility between the DRA- and FT-derived strain parameters. Both CMR-derived LVGLS and LVGRS were significantly related to the presence of LGE, and multivariate logistic regression analyses showed that the LVGLS measurement obtained from both techniques was independently associated with the presence of LGE. The odds ratios (ORs) for DRA- and FT-LVGLS were 1.340 and 1.342, respectively. CONCLUSIONS Asymptomatic HT patients with preserved LVEF exhibited reduced myocardial strain parameters. The CMR-derived LVGLS was independently related to the presence of LGE in HT patients. KEY POINTS • Reduced myocardial strain parameters were found in asymptomatic heart transplanted (HT) patients with normal left ventricular ejection fraction (LVEF). • The deformation registration algorithm (DRA) and feature tracking (FT)-derived strains in asymptomatic HT patients had high reproducibility. • DRA- and FT-derived LVGLS had an independent relationship with late gadolinium enhancement (LGE) in asymptomatic HT patients.
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17
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Ran H, Zhang PY, Ma XW, Dong J, Wu WF. Left and right ventricular function detection and myocardial deformation analysis in heart transplant patients with long-time follow-ups. J Card Surg 2020; 35:755-763. [PMID: 32048345 DOI: 10.1111/jocs.14461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We try to investigate whether the values of longitudinal strain present differences between the left and right ventricles in long-time follow-ups after heart transplantation (HTx) with dynamic changes in function. METHODS AND RESULTS Follow-up transthoracic echocardiography was performed in 1- and 3-month and 1- and 5-year follow-ups in 50 "healthy" HTx patients and compared with 26 control subjects. The left ventricle with preserved ejection fraction evaluated by biplane Simpson (control group [CG] vs HT; P > .05) had an obvious reduction in global (CG: -20.49 ± 2.38 vs heart transplant 1 month [HT1m]: -13.06 ± 2.86, heart transplant 3 month [HT3m]: -13.61 ± 2.61, heart transplant 1 year [HT1y]: -13.69 ± 4.56, heart transplant 5 year [HT5y]: -14.41 ± 4.54; P < .001) and horizontal segmental (basal, mid, apical) (P < .001) together with chamber segmental (apical 4-chamber, apical 3-chamber, apical 2-chamber) (P < .001) average strain values. The right ventricle with reduced ventricular function measured by tissue Doppler imaging S' and tricuspid annular plane systolic excursion had a more distinctive reduction in global (CG: -24.53 ± 4.20 vs HT1m: -12.94 ± 5.03, HT3m: -13.68 ± 4.35, HT1y: -14.95 ± 7.50, HT5y: -15.20 ± 6.15; P < .001) with segmental lateral (P < .001) strain values. There were not any significant changes between 1- and 3-month follow-ups of all the values (P > .05). But it could be seen that values increased in 1- and 5-year follow-ups compared with the baseline of 1- and 3-month follow-ups (P < .05). The global and segmental strain of the right ventricle decreased more than that of the left ventricle in all HTx groups, and the strain values were decreased in the HTx groups compared with the CG, with the global decreased change rates being 11%, 10%, 6%, and 8%, respectively. CONCLUSIONS The strain values decreased after HTx and almost remained stable in the long-time follow-ups. Compared with the CG in both ventricles, they were with preserved or reduced functions. In addition, the deformation values of the right ventricle decreased more than those of the left.
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Affiliation(s)
- Hong Ran
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping-Yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao-Wu Ma
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Dong
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wen-Fang Wu
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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18
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Abstract
The assessment of pediatric patients after orthotropic heart transplantation (OHT) relies heavily on non-invasive imaging. Because of the potential risks associated with cardiac catheterization, expanding the role of non-invasive imaging is appealing. Echocardiography is fast, widely available, and can provide an accurate assessment of chamber sizes and function. Advanced echocardiographic methods, such as myocardial deformation, have potential to assess for acute rejection or cardiac allograft vasculopathy (CAV). While not currently part of routine care, cardiac magnetic resonance imaging (CMR) and computed tomography may potentially aid in the detection of graft complications following OHT. In particular, CMR tissue characterization holds promise for diagnosing rejection, while quantitative perfusion and myocardial late gadolinium enhancement may have a role in the detection of CAV. This review will evaluate standard and novel methods for non-invasive assessment of pediatric patients after OHT.
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Affiliation(s)
- Jonathan H Soslow
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Margaret M Samyn
- Medical College of Wisconsin, Pediatrics (Cardiology), Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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19
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Berhane H, Ruh A, Husain N, Robinson JD, Rigsby CK, Markl M. Myocardial velocity, intra-, and interventricular dyssynchrony evaluated by tissue phase mapping in pediatric heart transplant recipients. J Magn Reson Imaging 2019; 51:1212-1222. [PMID: 31515865 DOI: 10.1002/jmri.26916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endomyocardial biopsy (EMB) is the standard method for detecting allograft rejection in pediatric heart transplants (Htx). As EMB is invasive and carries a risk of complications, there is a need for a noninvasive alternative for allograft monitoring. PURPOSE To quantify left and right ventricular (LV & RV) peak velocities, velocity twist, and intra-/interventricular dyssynchrony using tissue phase mapping (TPM) in pediatric Htx compared with controls, and to explore the relationship between global cardiac function parameters and the number of rejection episodes to these velocities and intra-/interventricular dyssynchrony. STUDY TYPE Prospective. SUBJECTS Twenty Htx patients (age: 16.0 ± 3.1 years, 11 males) and 18 age- and sex-matched controls (age: 15.5 ± 4.3 years, nine males). FIELD STRENGTH/SEQUENCE 5T; 2D balanced cine steady-state free-precession (bSSFP), TPM (2D cine phase contrast with three-directional velocity encoding). ASSESSMENT LV and RV circumferential, radial, and long-axis velocity-time curves, global and segmental peak velocities were measured using TPM. Short-axis bSSFP images were used to measure global LV and RV function parameters. STATISTICAL TESTS A normality test (Lilliefors test) was performed on all data. For comparisons, a t-test was used for normally distributed data or a Wilcoxon rank-sum test otherwise. Correlations were determined by a Pearson correlation. RESULTS Htx patients had significantly reduced LV (P < 0.05-0.001) and RV (P < 0.05-0.001) systolic and diastolic global and segmental long-axis velocities, reduced RV diastolic peak twist (P < 0.01), and presented with higher interventricular dyssynchrony for long-axis and circumferential motions (P < 0.05-0.001). LV diastolic long-axis dyssynchrony (r = 0.48, P = 0.03) and RV diastolic peak twist (r = -0.64, P = 0.004) significantly correlated with the total number of rejection episodes. DATA CONCLUSION TPM detected differences in biventricular myocardial velocities in pediatric Htx patients compared with controls and indicated a relationship between Htx myocardial velocities and rejection history. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1212-1222.
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Affiliation(s)
- Haben Berhane
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alexander Ruh
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nazia Husain
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua D Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
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20
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Sade LE, Hazirolan T, Kozan H, Ozdemir H, Hayran M, Eroglu S, Pirat B, Sezgin A, Muderrisoglu H. T1 Mapping by Cardiac Magnetic Resonance and Multidimensional Speckle-Tracking Strain by Echocardiography for the Detection of Acute Cellular Rejection in Cardiac Allograft Recipients. JACC Cardiovasc Imaging 2019; 12:1601-1614. [DOI: 10.1016/j.jcmg.2018.02.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
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21
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Sahewalla R, Sehgal S, Blake J, Aggarwal S. Left ventricular adaptation following orthotopic heart transplantation in children: A speckle tracking echocardiographic imaging study. Clin Transplant 2019; 33:e13632. [PMID: 31309613 DOI: 10.1111/ctr.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evolution of left ventricle (LV) function in the pediatric OHT population has not been well described. Our hypothesis was that, in children following OHT without any rejection, there would be progressive normalization of LV size and function over 2 years. METHODS LV function was evaluated using STE and conventional echo parameters at five time points in pediatric OHT patients without any rejection in the first 2 years following OHT and normal controls. LV global peak systolic longitudinal strain (LVPLS) and strain rate, LV peak systolic radial and circumferential strain (LVRS and LVCS), and strain rate were analyzed. RESULTS We had twenty two patients with median age at OHT of 1.27 years ( IQR 0.19, 5.6 years). The LVPLS (mean ± SD) was abnormal in the post-OHT echocardiograms at 1 week (-12.4 ± 3.7) and 1 month (-13.9 ± 3.7) and significantly improved at 6 months (-15.8 ± 3.2), 1 year (-15.7 ± 3.1), and 2 years (-17.8 ± 2.8). However, LVPLS remained below the normal group even at 2 years following OHT (-21.3 ± 1.76). CONCLUSION In children following OHT, despite the absence of rejection, strain values are significantly impaired in the initial months, improve progressively over the first 2 years but remain abnormal compared with healthy controls.
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Affiliation(s)
- Rini Sahewalla
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Swati Sehgal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Jennifer Blake
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
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22
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Temporal changes in left ventricular strain with the development of rejection in paediatric heart transplant recipients. Cardiol Young 2019; 29:954-959. [PMID: 31204638 PMCID: PMC6715531 DOI: 10.1017/s1047951119001185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Myocardial strain measurements are increasingly used to detect complications following heart transplantation. However, the temporal association of these changes with allograft rejection is not well defined. The aim of this study was to describe the evolution of strain measurements prior to the diagnosis of rejection in paediatric heart transplant recipients. METHODS All paediatric heart transplant recipients (2004-2015) with at least one episode of acute rejection were identified. Longitudinal and circumferential strain measurements were assessed at the time of rejection and retrospectively on all echocardiograms until the most recent negative biopsy. Smoothing technique (LOESS) was used to visualise the changes of each variable over time and estimate the time preceding rejection at which alterations are first detectable. RESULTS A total of 58 rejection episodes were included from 37 unique patients. In the presence of rejection, there were decrements from baseline in global longitudinal strain (-18.2 versus -14.1), global circumferential strain (-24.1 versus -19.6), longitudinal strain rate (-1 versus -0.8), circumferential strain rate (-1.3 versus -1.1), peak longitudinal early diastolic strain rate (1.3 versus 1), and peak circumferential early diastolic strain rate (1.5 versus 1.3) (p<0.01 for all). The earliest detectable changes occurred 45 days prior to rejection with simultaneous alterations in myocardial strain and ejection fraction. CONCLUSIONS Changes in graft function can be detected non-invasively prior to the diagnosis of rejection. However, changes in strain occur concurrently with a decline in ejection fraction. Strain measurements aid in the non-invasive detection of rejection, but may not facilitate earlier diagnosis compared to more traditional measures of ventricular function.
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23
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Ingvarsson A, Werther-Evaldsson A, Smith GJ, Waktare J, Nilsson J, Stagmo M, Roijer A, Rådegran G, Meurling C. Impact of gender on echocardiographic characteristics in heart transplant recipients. Clin Physiol Funct Imaging 2019; 39:246-254. [PMID: 30770630 DOI: 10.1111/cpf.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
AIMS Assessment following heart transplantation (HTx) is routinely performed using transthoracic echocardiography. Differences in long-term mortality following HTx related to donor-recipient matching have been reported, but effects of gender on cardiac size and function are not well studied. The aims of this study were to evaluate differences in echocardiographic characteristics of HTx recipients defined by gender. METHODS AND RESULTS The study prospectively enrolled 123 (n = 34 female) HTx recipients of which 23 recipients was donor-recipient gender mismatched. Patients were examined with 2-dimensional echocardiography using Philips iE33 ultrasound system. Data were analysed across strata based on recipient gender and gender mismatch. Male recipients had larger left ventricular (LV) mass, thicker septal wall (P<0·001) and larger absolute LV volumes (P<0·001). Mean LV ejection fraction (EF) was higher in females (P<0·05), but no differences in conventional parameters of right ventricular (RV) function were found. Ventricular strain was higher in females than in males: LV global longitudinal strain (P<0·01), RV global longitudinal strain (P<0·05) and RV lateral free wall (P<0·05). The male group receiving a female donor heart had comparable EF and strain parameters to the female group receiving a gender-matched heart. CONCLUSION We found that female recipient gender was associated with smaller chamber size, higher LV EF and better LV and RV longitudinal strain. Gender-mismatched male recipients appeared to exhibit function parameters similar to gender-matched female recipients. Our results indicate that the gender aspect, analogous to current reference guidelines in general population, should be taken into consideration when examining patients post-HTx.
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Affiliation(s)
- Annika Ingvarsson
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Anna Werther-Evaldsson
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Gustav J Smith
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Lund University Diabetes Center, Lund University, Lund, Sweden
| | | | - Johan Nilsson
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Lund, Sweden
| | - Martin Stagmo
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Anders Roijer
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Carl Meurling
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
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24
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Tseng AS, Gorsi US, Barros-Gomes S, Miller FA, Pellikka PA, Clavell AL, Villarraga HR. Use of speckle-tracking echocardiography-derived strain and systolic strain rate measurements to predict rejection in transplant hearts with preserved ejection fraction. BMC Cardiovasc Disord 2018; 18:241. [PMID: 30579333 PMCID: PMC6303897 DOI: 10.1186/s12872-018-0980-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Noninvasive diagnosis of allograft rejection in heart transplant recipients is challenging. The utility of 2-dimensional speckle-tracking echocardiography (2D-STE) to predict severe rejection in heart transplant recipients with preserved left ventricular ejection fraction (LVEF) was evaluated. METHODS Adult heart transplant patients with preserved LVEF (> 55%) and severe rejection by biopsy (Rejection Grade ≥ 2R) or no rejection between 1997 and 2011 at the Mayo Clinic in Rochester, Minnesota were evaluated. Transthoracic echocardiography was performed within 1 month of the biopsy. LV global longitudinal and circumferential strain and strain rates (GLS, GLSR, GCS, and GCSR) were analyzed retrospectively. RESULTS Of 65 patients included, 25 had severe rejection and 40 were normal transplant controls without rejection. Both groups had more men than women (64 and 75%, respectively). Baseline clinical variables were similar between the groups. Both groups had normal LVEF (64.3% vs 64.5%; P = .87). All non-strain echocardiographic variables were similar between the 2 groups. Strain analysis showed significantly increased early diastolic longitudinal strain rate (P = .02) and decreased GCS (P < .001) and GCSR (P = .02) for the rejection group compared with the control group. The area under the receiver operating characteristic curve for GCS was 0.77. With a GCS cutoff of - 17.60%, the sensitivity and specificity of GCS to detect severe acute rejection were 81.8 and 68.4%, respectively. CONCLUSIONS 2D-STE may be useful in detecting severe transplant rejection in heart transplant patients with normal LVEF.
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Affiliation(s)
- Andrew S Tseng
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Umama S Gorsi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First St SW, Rochester, MN, 55905, USA
| | - Sergio Barros-Gomes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First St SW, Rochester, MN, 55905, USA
| | - Fletcher A Miller
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First St SW, Rochester, MN, 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First St SW, Rochester, MN, 55905, USA
| | - Alfredo L Clavell
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First St SW, Rochester, MN, 55905, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First St SW, Rochester, MN, 55905, USA.
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25
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Cote AT, Hosking M, Voss C, Human DG, Sandor GGS, Harris KC. Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients. CONGENIT HEART DIS 2018; 13:663-670. [DOI: 10.1111/chd.12629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Anita T. Cote
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- School of Human Kinetics; Trinity Western University; Langley Canada
| | - Martin Hosking
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Christine Voss
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Derek G Human
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - George G. S. Sandor
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Kevin C. Harris
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
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26
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Antończyk K, Niklewski T, Antończyk R, Zakliczyński M, Zembala M, Kukulski T. Evaluation of the Graft Mechanical Function Using Speckle-Tracking Echocardiography During the First Year After Orthotropic Heart Transplantation. Ann Transplant 2018; 23:554-560. [PMID: 30087315 PMCID: PMC6248016 DOI: 10.12659/aot.909359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Recent advances in ultrasound strain imaging facilitate more precise monitoring of subtle myocardial changes and thus may allow for more appropriate assessment of myocardium after orthotopic heart transplantation (OHT). This study aimed to explore longitudinal left ventricular (LV) and right ventricular (RV) function by speckle-tracking echocardiography (STE) during a 12-month follow-up period in relation to acute cellular rejection (ACR) degree ≥2R and the response to intense immunosuppressive therapy with intravenous steroids. Material/Methods Forty-five adult heart transplant recipients were prospectively assessed at a single center from January 2016 until June 2017. Echocardiography was performed serially at baseline and together with routine biopsies at 2 weeks and 1, 2, 3, 6, 9, and 12 months after OHT. Changes in graft function were evaluated using STE before and during ACR and in the resolving period of ACR. Results A total of 220 pairs of biopsy specimens and strain recordings were analyzed. Moderate ACR was seen in 30 biopsies (13.6%). In the serial assessment, longitudinal strain parameters of the LV (global and 4-, 2-, 3-chamber longitudinal strain) and RV (global and free wall longitudinal strain) were decreased at baseline and improved significantly (P<0.001) within 12 months after OHT. The degree of improvement was not influenced by ACR. There were no significant differences in circumferential, radial, or longitudinal strain rate, or mechanical dyssynchrony. Reduced LV and RV longitudinal strain was related to ACR degree 2R and increased significantly (P<0.0005) during 3 days of intravenous methylprednisolone therapy. Conclusions Using the STE technique, we have documented an acute improvement in mechanical myocardial function following ACR steroid therapy and a progressive recovery of LV and RV longitudinal function during the first year after OHT.
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Affiliation(s)
- Karolina Antończyk
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Tomasz Niklewski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Remigiusz Antończyk
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Michael Zakliczyński
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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27
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Godown J, Dodd DA, Stanley M, Havens C, Xu M, Slaughter JC, Bearl DW, Soslow JH. Changes in left ventricular strain parameters following pediatric heart transplantation. Pediatr Transplant 2018; 22:e13166. [PMID: 29575396 PMCID: PMC6047919 DOI: 10.1111/petr.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
STE is increasingly utilized to assess strain in a variety of pathologies. Strain measurements have demonstrated utility following HTx and may aid in the detection of rejection and CAV. Strain parameters have not been well defined in the pediatric HTx population. This study aimed to describe strain in pediatric HTx recipients compared to controls and assess changes over time. All pediatric HTx recipients with available echocardiograms (2004-2015) without rejection or CAV were identified. Longitudinal and circumferential strain was measured at <1 month, 1 year, 3 years, and 5 years post-transplant and compared to controls. A total of 218 echocardiograms were analyzed in 79 HTx recipients. At <1 month post-transplant, there was a significant decrement in longitudinal strain (GLS -14.6 vs -19.2, P < .001) with concurrent augmentation of circumferential strain (GCS -27.3 vs -24.3, P = .005). By 1 year post-HTx, all strain parameters normalized and were not significantly different from the control population. In the absence of graft complications, strain parameters did not change up to 5 years post-transplant. Abnormal longitudinal strain parameters are present in the early post-HTx period with a compensatory increase in circumferential strain. These changes normalize by 1 year post-transplant and do not change over time in the absence of graft complications.
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Affiliation(s)
- Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Debra A. Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Michael Stanley
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Corey Havens
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - James C. Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - David W. Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
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28
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Long-term prognostic value of invasive and non-invasive measures early after heart transplantation. Int J Cardiol 2018; 260:31-35. [PMID: 29622448 DOI: 10.1016/j.ijcard.2018.01.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Invasively assessed coronary microvascular resistance early after heart transplantation predicts worse long-term outcome; however, little is known about the relationship between microvascular resistance, left ventricular function and outcomes in this setting. METHODS A total of 100 cardiac transplant recipients had fractional flow reserve (FFR) and the index of microcirculatory resistance (IMR) measured in the left anterior descending artery and echocardiographic assessment of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) at 1 year after heart transplantation. The primary endpoint was the composite of death and retransplantation occurring beyond the first post-operative year. RESULTS The mean FFR, IMR, LVEF, and GLS values at 1 year were 0.87 ± 0.06, 21.3 ± 17.3, 60.4 ± 5.4%, and 14.2 ± 2.4%, respectively. FFR and IMR had no significant correlation with LVEF and GLS. During a mean follow-up of 6.7 ± 4.2 years, the primary endpoint occurred in 24 patients (24.0%). By ROC curve analysis, IMR = 19.3 and GLS = 13.3% were the best cutoff values for predicting death or retransplantation. Cumulative event-free survival was significantly lower in patients with higher IMR (log-rank p = 0.02) and lower GLS (log-rank p < 0.001). Cumulative event-free survival can be further stratified by the combination of IMR and GLS (long-rank p < 0.001). By multivariable Cox proportional hazards model, higher IMR and lower GLS were independently associated with long-term death or retransplantation (elevated IMR, hazard ratio = 2.50, p = 0.04 and reduced GLS, hazard ratio = 3.79, p = 0.003, respectively). CONCLUSION Invasively assessed IMR does not correlate with GLS at 1 year after heart transplantation. IMR and GLS determined at 1 year may be used as independent predictors of late death or retransplantation.
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Ingvarsson A, Werther Evaldsson A, Waktare J, Nilsson J, Smith GJ, Stagmo M, Roijer A, Rådegran G, Meurling CJ. Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation. J Am Soc Echocardiogr 2017; 31:349-360. [PMID: 29275986 DOI: 10.1016/j.echo.2017.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients. METHODS The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects. RESULTS Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62 ± 7%, P < .01) and global longitudinal strain (-16.5 ± 3.3%, P < .0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P < .0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15 ± 4 mm [P < .0001], RV systolic tissue Doppler velocity 10 ± 6 cm/sec [P < .0001], fractional area change 40 ± 8% [P < .0001], and RV free wall strain -16.9 ± 4.2% [P < .0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection. CONCLUSION The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.
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Affiliation(s)
- Annika Ingvarsson
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden.
| | - Anna Werther Evaldsson
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Johan Waktare
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Johan Nilsson
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Lund, Sweden
| | - Gustav J Smith
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Martin Stagmo
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Anders Roijer
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Carl J Meurling
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
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Kobayashi Y, Sudini NL, Rhee JW, Aymami M, Moneghetti KJ, Bouajila S, Kobayashi Y, Kim JB, Schnittger I, Teuteberg JJ, Khush KK, Fearon WF, Haddad F. Incremental Value of Deformation Imaging and Hemodynamics Following Heart Transplantation. JACC-HEART FAILURE 2017; 5:930-939. [DOI: 10.1016/j.jchf.2017.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
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Wang D, Zhang L, Zeng Q, Xie M. Assessment of left ventricular performance in heart transplant recipients by three-dimensional speckle tracking imaging. Medicine (Baltimore) 2017; 96:e8129. [PMID: 29019881 PMCID: PMC5662304 DOI: 10.1097/md.0000000000008129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To calculate left ventricular (LV) global performance values in heart transplant (HT) recipients by three-dimensional speckle tracking imaging (3D-STI) and to observe the changes in LV global performance over time after HT and investigate the correlated factors.The 30 HT patients were divided into 2 groups according to postoperative time: 1 month postoperatively (HT-1) group and 6 months postoperatively (HT-2) group. Thirty healthy subjects were enrolled as control group. 3D-STI was performed to assess LV torsion, LV systolic dyssynchrony index (SDI), and LV global strain (GS). Global performance index (GPI) was calculated, and correlations factors with GPI were studied.Heart rate (HR), left atrium (LA), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass (LVM) in both HT groups were higher than those in the control group. Compared with the control group, SDI was significantly higher in both HT groups, and SDI of the HT-1 group was much higher than that of HT-2 group. Compared with the control group, apical rotation (RoA), twist and torsion in the both HT groups decreased significantly. There were no significant differences in these values between the 2 HT groups; Basal rotation (RoB) showed no significantly difference among the 3 groups. GS in the both HT groups decreased significantly compared with the control group, and there were no significant differences in these values between the 2 HT groups. GPI of the both HT groups was significantly lower than that of the control group; however, GPI of HT-2 group was higher than that of HT-1 group. Multivariate stepwise regression analysis identified global left ventricular longitudinal peak systolic strain (GLS), the time length since surgery, left ventricular mass (LVM), and RoA as predictors of LV GPI. GLS was the most influential to GPI.The values of LV rotation, twist and SDI can be used to assess the LV systolic function and dyssynchrony. The GPI value based on 3D-STI may accurately reflect LV performance changes over time after HT. The GPI value has potential applications in clinical practice. GLS, the time length since surgery, LVM and RoA values can be the predictors of LV global performance, and as long as the left ventricular ejection fraction (LVEF) is preserved, the left ventricular global performance of HT recipients remains stable, and tends to improve over time after HT.
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Affiliation(s)
- Dan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Qingyu Zeng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
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Simsek E, Nalbantgil S, Ceylan N, Zoghi M, Kemal HS, Engin C, Yagdi T, Ozbaran M. Assessment of right ventricular systolic function in heart transplant patients: Correlation between echocardiography and cardiac magnetic resonance imaging. Investigation of the accuracy and reliability of echocardiography. Echocardiography 2017; 34:1432-1438. [DOI: 10.1111/echo.13650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Evrim Simsek
- Department of Cardiology; School of Medicine; Ege University; Izmir Turkey
| | - Sanem Nalbantgil
- Department of Cardiology; School of Medicine; Ege University; Izmir Turkey
| | - Naim Ceylan
- Department of Radiology; School of Medicine; Ege University; Izmir Turkey
| | - Mehdi Zoghi
- Department of Cardiology; School of Medicine; Ege University; Izmir Turkey
| | - Hatice Soner Kemal
- Department of Cardiology; School of Medicine; Near East University; Lefkose Cyprus
| | - Cagatay Engin
- Department of Cardiovascular Surgery; School of Medicine; Ege University; Izmir Turkey
| | - Tahir Yagdi
- Department of Cardiovascular Surgery; School of Medicine; Ege University; Izmir Turkey
| | - Mustafa Ozbaran
- Department of Cardiovascular Surgery; School of Medicine; Ege University; Izmir Turkey
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Barakat AF, Sperry BW, Starling RC, Mentias A, Popovic ZB, Griffin BP, Desai MY. Prognostic Utility of Right Ventricular Free Wall Strain in Low Risk Patients After Orthotopic Heart Transplantation. Am J Cardiol 2017; 119:1890-1896. [PMID: 28390683 DOI: 10.1016/j.amjcard.2017.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 01/13/2023]
Abstract
Global longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive measure of regional left and right ventricular (LV and RV) dysfunction, before onset of overt systolic dysfunction. We sought to evaluate the prognostic utility of measuring LV-GLS and RV free wall strain (FWS) in low risk patients at 1 year after orthotopic heart transplantation (OHT). We retrospectively studied 96 OHT recipients (age 52 ± 14 years, 64% men) free of antibody-mediated rejection or moderate to severe coronary allograft vasculopathy (CAV, grade 2 to 3) at 1 year after transplant. LV-GLS and RV-FWS were calculated using EchoPAC software. Cox models were developed after adjusting for the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score (post-transplant risk score), with the primary outcome of death, moderate to severe CAV, or treated rejection. At 1 year after transplant, LV ejection fraction and RV fractional area change (FAC) were 58 ± 7% and 42 ± 10%, respectively. LV-GLS was -17.0 ± 3.3% and RV-FWS -16.4 ± 4.5%. At an average follow-up of 4.5 years, 28 patients met the primary end point (10 death, 5 vasculopathy, 17 rejection). In sequential Cox models, markers of RV function were associated with the primary outcome (RV-FAC, p = 0.012; RV-FWS, p = 0.022), while LV ejection fraction and LV-GLS were not. We conclude that in low risk patients 1 year after OHT, markers of RV function (RV-FAC and RV-FWS) are independently associated with incident rejection, CAV, and death. Markers of RV dysfunction could potentially be incorporated into risk scores and future prospective studies to risk stratify patients after OHT.
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Wisotzkey BL, Jorgensen NW, Albers EL, Kemna MS, Boucek RJ, Kronmal RA, Law YM, Bhat AH. Feasibility and interpretation of global longitudinal strain imaging in pediatric heart transplant recipients. Pediatr Transplant 2017; 21. [PMID: 28295946 DOI: 10.1111/petr.12909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/07/2023]
Abstract
Evaluation of myocardial mechanics after heart transplant is important in monitoring allograft function and identifying rejection. Speckle tracking global longitudinal strain (GLS) may be more sensitive to early regional changes from rejection. This study aimed to determine feasibility of GLS in pediatric hearts during surveillance echocardiograms, compare their GLS to published norms (-18% to -22%), and assess association of GLS with other indices of graft function. Retrospective review of transplant echocardiograms from 2013 to 2014. Philips QLAB was used for post-acquisition GLS analysis. Multiple linear regression was used to assess the association of GLS with echocardiographic/catheterization indices, and B-type natriuretic peptide (BNP). Forty-seven patients (84 studies) were included. Calculation of GLS was feasible in 82 studies (97%) with inter- and intra-observer variability of 0.71 and 0.69. Patients (n=9) with rejection had GLS of -16.4% (SD=3.5%) compared to those without [-16.8% (SD=3.7%)]. GLS worsened linearly with increasing Ln(BNP) (P=<.001), left ventricular volume in diastole (P=<.001), septal a' wave (P=<.001), and pulmonary capillary wedge pressure (P=<.001). Speckle tracking-based GLS is feasible and reproducible in pediatric heart recipients and is reduced at baseline. The role of GLS and BNP in detecting early systolic dysfunction warrants further investigation.
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Affiliation(s)
- Bethany L Wisotzkey
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Neal W Jorgensen
- Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Erin L Albers
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Mariska S Kemna
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Robert J Boucek
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard A Kronmal
- Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Yuk M Law
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Aarti H Bhat
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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Chinali M, Esposito C, Grutter G, Iacobelli R, Toscano A, D’Asaro MG, Pasqua AD, Brancaccio G, Parisi F, Drago F, Rinelli G. Cardiac dysfunction in children and young adults with heart transplantation: A comprehensive echocardiography study. J Heart Lung Transplant 2017; 36:559-566. [DOI: 10.1016/j.healun.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/28/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022] Open
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36
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DeVore AD, Alenezi F, Krishnamoorthy A, Ersboll M, Samsky MD, Schulte PJ, Patel CB, Rogers JG, Milano CA, Velazquez EJ, Khouri MG. Assessment of cardiac allograft systolic function by global longitudinal strain: From donor to recipient. Clin Transplant 2017; 31. [PMID: 28294407 DOI: 10.1111/ctr.12961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac allografts are routinely evaluated by left ventricular ejection fraction (LVEF) before and after transplantation. However, myocardial deformation analyses with LV global longitudinal strain (GLS) are more sensitive for detecting impaired LV myocardial systolic performance compared with LVEF. METHODS We analyzed echocardiograms in 34 heart donor-recipient pairs transplanted at Duke University from 2000 to 2013. Assessments of allograft LV systolic function by LVEF and/or LV GLS were performed on echocardiograms obtained pre-explanation in donors and serially in corresponding recipients. RESULTS Donors had a median LVEF of 55% (25th, 75th percentile, 54% to 60%). Median donor LV GLS was -14.6% (-13.7 to -17.3%); LV GLS was abnormal (ie, >-16%) in 68% of donors. Post-transplantation, LV GLS was further impaired at 6 weeks (median -11.8%; -11.0 to -13.4%) and 3 months (median -11.4%; -10.3 to -13.9%) before recovering to pretransplant levels in follow-up. Median LVEF remained ≥50% throughout follow-up. We found no association between donor LV GLS and post-transplant outcomes, including all-cause hospitalization and mortality. CONCLUSIONS GLS demonstrates allograft LV systolic dysfunction in donors and recipients not detected by LVEF. The clinical implications of subclinical allograft dysfunction detected by LV GLS require further study.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Fawaz Alenezi
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Arun Krishnamoorthy
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Mads Ersboll
- Department of Cardiology, The Heart Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marc D Samsky
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Phillip J Schulte
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Chetan B Patel
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Joseph G Rogers
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Carmelo A Milano
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Velazquez
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michel G Khouri
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Grotenhuis HB, Nyns ECA, Kantor PF, Dipchand AI, Greenway SC, Yoo SJ, Tomlinson G, Chaturvedi RR, Grosse-Wortmann L. Abnormal Myocardial Contractility After Pediatric Heart Transplantation by Cardiac MRI. Pediatr Cardiol 2017; 38:1198-1205. [PMID: 28555404 PMCID: PMC5514218 DOI: 10.1007/s00246-017-1642-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Abstract
Acute cellular rejection (ACR) compromises graft function after heart transplantation (HTX). The purpose of this study was to describe systolic myocardial deformation in pediatric HTX and to determine whether it is impaired during ACR. Eighteen combined cardiac magnetic resonance imaging (CMR)/endomyocardial biopsy (EMBx) examinations were performed in 14 HTX patients (11 male, age 13.9 ± 4.7 years; 1.2 ± 1.3 years after HTX). Biventricular function and left ventricular (LV) circumferential strain, rotation, and torsion by myocardial tagging CMR were compared to 11 controls as well as between patients with and without clinically significant ACR. HTX patients showed mildly reduced biventricular systolic function when compared to controls [LV ejection fraction (EF): 55 ± 8% vs. 61 ± 3, p = 0.02; right ventricular (RV) EF: 48 ± 7% vs. 53 ± 6, p = 0.04]. Indexed LV mass was mildly increased in HTX patients (67 ± 14 g/m2 vs. 55 ± 13, p = 0.03). LV myocardial deformation indices were all significantly reduced, expressed by global circumferential strain (-13.5 ± 2.3% vs. -19.1 ± 1.1%, p < 0.01), basal strain (-13.7 ± 3.0% vs. -17.5 ± 2.4%, p < 0.01), mid-ventricular strain (-13.4 ± 2.7% vs. -19.3 ± 2.2%, p < 0.01), apical strain (-13.5 ± 2.8% vs. -19.9 ± 2.0%, p < 0.01), basal rotation (-2.0 ± 2.1° vs. -5.0 ± 2.0°, p < 0.01), and torsion (6.1 ± 1.7° vs. 7.8 ± 1.1°, p < 0.01). EMBx demonstrated ACR grade 0 R in 3 HTX cases, ACR grade 1 R in 11 HTX cases and ACR grade 2 R in 4 HTX cases. When comparing clinically non-significant ACR (grades 0-1 R vs. ACR 2 R), basal rotation, and apical rotation were worse in ACR 2 R patients (-1.4 ± 1.8° vs. -4.2 ± 1.4°, p = 0.01 and 10.2 ± 2.9° vs. 2.8 ± 1.9°, p < 0.01, respectively). Pediatric HTX recipients demonstrate reduced biventricular systolic function and decreased myocardial contractility. Myocardial deformation indices by CMR may serve as non-invasive markers of graft function and, perhaps, rejection in pediatric HTX patients.
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Affiliation(s)
- Heynric B Grotenhuis
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Emile C A Nyns
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Paul F Kantor
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Anne I Dipchand
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Steven C Greenway
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Departments of Paediatrics and Cardiac Sciences, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Shi-Joon Yoo
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, Toronto General Hospital and Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rajiv R Chaturvedi
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of, Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17:412. [DOI: 10.1093/ehjci/jew041] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Moñivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J, Rodriguez Gonzalez E, Restrepo Córdoba MA, Jiménez Sanchez D, Rivero Arribas B, Garcia Lunar I, Mitroi CD, Sayago Silva I, Cavero Gibanel MA, Gómez Bueno M, Alonso Pulpón LA, Segovia Cubero J. Two-Dimensional Speckle Tracking Echocardiography in Heart Transplant Patients: Two-Year Follow-Up of Right and Left Ventricular Function. Echocardiography 2016; 33:703-13. [DOI: 10.1111/echo.13169] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Susana Mingo Santos
- Department of Cardiac Imaging; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | | | | | | | - Diego Jiménez Sanchez
- Department of Cardiac Imaging; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | - Betsaida Rivero Arribas
- Department of Cardiac Imaging; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | - Inés Garcia Lunar
- Department of Cardiac Imaging; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | - Cristina D. Mitroi
- Department of Cardiac Imaging; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | - Ines Sayago Silva
- Department of Cardiac Imaging; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | | | - Manuel Gómez Bueno
- Department of Heart Failure; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | - Luis A. Alonso Pulpón
- Department of Heart Failure; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
| | - Javier Segovia Cubero
- Department of Heart Failure; University Hospital Puerta de Hierro Majadahonda; Madrid Spain
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Podrouzkova H, Bedanova H, Tretina M, Korinek J, Stepanova R, Hruskova J, Nemec P, Konecny T, Orban M. Decrease in longitudinal strain in heart transplant recipients is associated with rejection. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:601-6. [DOI: 10.5507/bp.2015.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 04/14/2015] [Indexed: 01/30/2023] Open
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Wang N, Hung CL, Shin SH, Claggett B, Skali H, Thune JJ, Køber L, Shah A, McMurray JJ, Pfeffer MA, Solomon SD. Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction. Eur Heart J 2015; 37:466-72. [DOI: 10.1093/eurheartj/ehv558] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/29/2015] [Indexed: 11/12/2022] Open
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Bech-Hanssen O, Pergola V, Al-Admawi M, Fadel BM, Di Salvo G. Atrial function in heart transplant recipients operated with the bicaval technique. SCAND CARDIOVASC J 2015; 50:42-51. [DOI: 10.3109/14017431.2015.1091946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Odd Bech-Hanssen
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
- Department of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Valeria Pergola
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Al-Admawi
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Bahaa M. Fadel
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Giovanni Di Salvo
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
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43
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Usefulness of Two-Dimensional Strain Parameters to Diagnose Acute Rejection after Heart Transplantation. J Am Soc Echocardiogr 2015; 28:1149-56. [DOI: 10.1016/j.echo.2015.06.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Indexed: 11/21/2022]
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44
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Mechanical Dyssynchrony and Abnormal Regional Strain Promote Erroneous Measurement of Systolic Function in Pediatric Heart Transplantation. J Am Soc Echocardiogr 2015; 28:1161-1170, e2. [DOI: 10.1016/j.echo.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Indexed: 11/20/2022]
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45
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Armstrong GT, Joshi VM, Ness KK, Marwick TH, Zhang N, Srivastava D, Griffin BP, Grimm RA, Thomas J, Phelan D, Collier P, Krull KR, Mulrooney DA, Green DM, Hudson MM, Robison LL, Plana JC. Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study. J Am Coll Cardiol 2015; 65:2511-22. [PMID: 26065990 DOI: 10.1016/j.jacc.2015.04.013] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/24/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment-related cardiac death is the primary, noncancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction may identify a high-risk subset of survivors for early intervention. OBJECTIVES This study sought to determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies. METHODS Echocardiographic assessment included 3-dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain, and diastolic function, graded per American Society of Echocardiography guidelines in 1,820 adult (median age 31 years; range: 18 to 65 years) survivors of childhood cancer (median time from diagnosis 23 years; range: 10 to 48 years) exposed to anthracycline chemotherapy (n = 1,050), chest-directed radiotherapy (n = 306), or both (n = 464). RESULTS Only 5.8% of survivors had abnormal 3D LVEFs (<50%). However, 32.1% of survivors with normal 3D LVEFs had evidence of cardiac dysfunction by global longitudinal strain (28%), American Society of Echocardiography-graded diastolic assessment (8.7%), or both. Abnormal global longitudinal strain was associated with chest-directed radiotherapy at 1 to 19.9 Gy (rate ratio [RR]: 1.38; 95% confidence interval [CI]: 1.14 to 1.66), 20 to 29.9 Gy (RR: 1.65; 95% CI: 1.31 to 2.08), and >30 Gy (RR: 2.39; 95% CI: 1.79 to 3.18) and anthracycline dose > 300 mg/m(2) (RR: 1.72; 95% CI: 1.31 to 2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (RR: 1.94; 95% CI: 1.66 to 2.28) and abnormal diastolic function (RR: 1.68; 95% CI: 1.39 to 2.03) but not abnormal 3D LVEFs (RR: 1.07; 95% CI: 0.74 to 1.53). CONCLUSIONS Abnormal global longitudinal strain and diastolic function are more prevalent than reduced 3D LVEF and are associated with treatment exposure. They may identify a subset of survivors at higher risk for poor clinical cardiac outcomes who may benefit from early medical intervention.
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Affiliation(s)
- Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Vijaya M Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas H Marwick
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Nan Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - DeoKumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian P Griffin
- Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio
| | - Richard A Grimm
- Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio
| | - James Thomas
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Dermot Phelan
- Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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46
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Badano LP, Miglioranza MH, Edvardsen T, Colafranceschi AS, Muraru D, Bacal F, Nieman K, Zoppellaro G, Marcondes Braga FG, Binder T, Habib G, Lancellotti P, Sicari R, Cosyns B, Donal E, Lombardi M, Sarvari S. European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation. ACTA ACUST UNITED AC 2015; 16:919-48. [DOI: 10.1093/ehjci/jev139] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/02/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Luigi P. Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy
| | - Fernando Bacal
- Heart Transplant Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Koen Nieman
- Intensive Cardiac Care Unit and Cardiac CT Research, Erasmus MC, Rotterdam, The Netherlands
| | - Giacomo Zoppellaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Thomas Binder
- Department of Cardiology, University of Vienna, Wien, Austria
| | - Gilbert Habib
- Service de Cardiologie, Hôpital La Timone, Marseille, France
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
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Clemmensen TS, Løgstrup BB, Eiskjær H, Poulsen SH. Serial changes in longitudinal graft function and implications of acute cellular graft rejections during the first year after heart transplantation. Eur Heart J Cardiovasc Imaging 2015; 17:184-93. [PMID: 26034093 DOI: 10.1093/ehjci/jev133] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/25/2015] [Indexed: 01/09/2023] Open
Abstract
AIMS The aim of this prospective study was to use left ventricular global longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of graft function in relation to acute cellular rejection (ACR) during the first year after heart transplantation (HTX). METHODS AND RESULTS The study population consisted of 36 patients undergoing HTX from November 2010 until October 2013. Patients were followed by comprehensive echocardiography and biopsies at 2 weeks and 1, 3, 6, and 12 months after HTX. ACRs were classified based on the ISHLT classification (0R-3R). Patients were divided into two groups according to the presence of one or more episodes of biopsy proven ≥grade 2R ACR during follow-up. We found that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were significantly related to ACR burden in a linear regression model. The absolute difference in LV-GLS between patients in the ACR group (-14.4%) and patients in the ACR-free group (-16.8%) was -2.4% (P < 0.01) 12 months after HTX. In the ACR group, patients' LV-GLS did not improve between 1 and 12 months, whereas an improvement of -2.9% was seen in the ACR-free group in this period (P < 0.01). The two groups appeared not to differ in terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE was 15.3 ± 2.8 mm in the ACR-free group vs. 13.2 ± 2.1 mm ACR group, P < 0.05, 12 months after HTX. CONCLUSION Gradual improvement of longitudinal LV and RV function was seen within the first year after HTX, but the degree of recovery was strongly influenced by ACR episodes.
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Affiliation(s)
- Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
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48
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Ambardekar AV, Alluri N, Patel AC, Lindenfeld J, Dorosz JL. Myocardial Strain and Strain Rate from Speckle-Tracking Echocardiography are Unable to Differentiate Asymptomatic Biopsy-Proven Cellular Rejection in the First Year after Cardiac Transplantation. J Am Soc Echocardiogr 2015; 28:478-85. [DOI: 10.1016/j.echo.2014.12.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Indexed: 12/13/2022]
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49
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Clemmensen TS, Løgstrup BB, Eiskjær H, Poulsen SH. Changes in Longitudinal Myocardial Deformation during Acute Cardiac Rejection: The Clinical Role of Two-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2015; 28:330-9. [DOI: 10.1016/j.echo.2014.10.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Indexed: 11/29/2022]
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Cardiac mechanics in heart transplant recipients with and without transplant vasculopathy. Int J Cardiovasc Imaging 2015; 31:795-803. [PMID: 25697723 DOI: 10.1007/s10554-015-0625-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/16/2015] [Indexed: 10/24/2022]
Abstract
Evaluation of cardiac mechanics in heart transplant recipients (HTR) is of paramount importance. Assessment of strain through echocardiography is suited to describe cardiac function and might allow characterizing patients with and without transplant vasculopathy (TVP) a risk factor of impaired organ function and rejection. For this study 41 HTR immediately after and 1-3 years after transplantation were examined in a retrospective approach with 2-dimensional speckle tracking echocardiography to assess longitudinal, radial and circumferential strain and strain rate. The cohort consists of 33 men and 8 women with a median age of 54 years (1st, 3rd; 45.7, 65.3) with seven cases diagnosed with TVP during follow-up, as diagnosed by coronary angiography. The overall cohort showed an improvement of global longitudinal strain from baseline to 1 and 3 years with -14.2% (-16.9, -12.3%) to -16.1% (-17.5, -14.3%) and -16.7% (-18, -13.7%), p = 0.036. For patients developing TVP, global longitudinal strain was not different from baseline up to the maximum of 3 years -16.6% (-16.7-13.8%) to -16.4% (-17.3, -14.7%) and -17.6% (-18.7, -16.9%) with p = 0.21. Radial strain and torsion showed a trend to decrease after transplantation with time. Circumferential strain remained stable in HTR but decreased in subjects with TVP. Longitudinal Strain and strain rate showed no relevant changes in HTR with and without TVP. Radial strain and torsion declined in HTR as well as TVP patients with time. Speckle tracking imaging is useful to assess organ function in HTR, however coronary angiography is still needed to rule out TVP.
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