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Bacich D, Tessari C, Ciccarelli G, Lucertini G, Cerutti A, Pradegan N, Toscano G, Di Salvo G, Gambino A, Gerosa G. A Comprehensive Excursus of the Roles of Echocardiography in Heart Transplantation Follow-Up. J Clin Med 2024; 13:3205. [PMID: 38892916 PMCID: PMC11172807 DOI: 10.3390/jcm13113205] [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: 04/24/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Current guidelines for the care of heart transplantation recipients recommend routine endomyocardial biopsy and invasive coronary angiography as the cornerstones in the surveillance for acute rejection (AR) and coronary allograft vasculopathy (CAV). Non-invasive tools, including coronary computed tomography angiography and cardiac magnetic resonance, have been introduced into guidelines without roles of their own as gold standards. These techniques also carry the risk of contrast-related kidney injury. There is a need to explore non-invasive approaches providing valuable information while minimizing risks and allowing their application independently of patient comorbidities. Echocardiographic examination can be performed at bedside, serially repeated, and does not carry the burden of contrast-related kidney injury and procedure-related risk. It provides comprehensive assessment of cardiac morphology and function. Advanced echocardiography techniques, including Doppler tissue imaging and strain imaging, may be sensitive tools for the detection of minor myocardial dysfunction, thus providing insight into early detection of AR and CAV. Stress echocardiography may offer a valuable tool in the detection of CAV, while the assessment of coronary flow reserve can unravel coronary microvascular impairment and add prognostic value to conventional stress echocardiography. The review highlights the role of Doppler echocardiography in heart transplantation follow-up, weighting advantages and limitations of the different techniques.
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Affiliation(s)
- Daniela Bacich
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Giulia Ciccarelli
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Giovanni Lucertini
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Alessia Cerutti
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (A.C.); (G.D.S.)
| | - Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Giuseppe Toscano
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (A.C.); (G.D.S.)
| | - Antonio Gambino
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (D.B.); (G.C.); (G.L.); (N.P.); (G.T.); (A.G.); (G.G.)
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2
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Randhawa MK, Sultana S, Stib MT, Nagpal P, Michel E, Hedgire S. Role of Radiology in Assessment of Postoperative Complications of Heart Transplantation. Radiol Clin North Am 2024; 62:453-471. [PMID: 38553180 DOI: 10.1016/j.rcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Heart transplantation is a pivotal treatment of end-stage heart failure, and recent advancements have extended median posttransplant life expectancy. However, despite the progress in surgical techniques and medical treatment, heart transplant patients still face complications such as rejection, infections, and drug toxicity. CT is a reliable tool for detecting most of these complications, whereas MR imaging is particularly adept at identifying pericardial pathologies and signs of rejection. Awareness of these nuances by radiologists, cardiologists, and surgeons is desired to optimize care, reduce morbidities, and enhance survival.
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Affiliation(s)
- Mangun K Randhawa
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sadia Sultana
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew T Stib
- Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Prashant Nagpal
- Division of Cardiovascular Imaging, Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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3
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Sciaccaluga C, Fusi C, Landra F, Barilli M, Lisi M, Mandoli GE, D’Ascenzi F, Focardi M, Valente S, Cameli M. Diastolic function in heart transplant: From physiology to echocardiographic assessment and prognosis. Front Cardiovasc Med 2022; 9:969270. [DOI: 10.3389/fcvm.2022.969270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Heart transplant (HTx) still represents the most effective therapy for end-stage heart failure, with a median survival time of 10 years. The transplanted heart shows peculiar physiology due to the profound alterations induced by the operation, which inevitably influences several echocardiographic parameters assessed during these patients’ follow-ups. With these premises, the diastolic function is one of the main aspects to take into consideration. The left atrium (LA) plays a key role in this matter, and that same chamber is significantly impaired with the transplant, with different degrees of altered function based on the surgical technique. Therefore, the traditional echocardiographic evaluation of diastolic function applied to the general population might not properly reflect the physiology of the graft. This review attempts to provide current evidence on diastolic function in HTx starting from defining its different physiology and how the standard echocardiographic parameters might be affected to its prognostic role. Furthermore, based on the experience of our center and the available evidence, we proposed an algorithm that might help clinicians distinguish from actual diastolic dysfunction from a normal diastolic pattern in HTx population.
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Masarone D, Kittleson M, Gravino R, Valente F, Petraio A, Pacileo G. The Role of Echocardiography in the Management of Heart Transplant Recipients. Diagnostics (Basel) 2021; 11:diagnostics11122338. [PMID: 34943575 PMCID: PMC8699946 DOI: 10.3390/diagnostics11122338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 01/30/2023] Open
Abstract
Transthoracic echocardiography is the primary non-invasive modality for the investigation of heart transplant recipients. It is a versatile tool that provides comprehensive information on cardiac structure and function. Echocardiography is also helpful in diagnosing primary graft dysfunction and evaluating the effectiveness of therapeutic approaches for this condition. In acute rejection, echocardiography is useful with suspected cellular or antibody-mediated rejection, with findings confirmed and quantified by endomyocardial biopsy. For identifying chronic rejection, ultrasound has a more significant role and, in some specific patients (e.g., patients with renal failure), it may offer a role comparable to coronary angiography to identify cardiac allograft vasculopathy. This review highlights the usefulness of echocardiography in evaluating normal graft function and its role in the management of heart transplant recipients.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
- Correspondence:
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA;
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplantology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy;
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
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5
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Sciaccaluga C, Ghionzoli N, Mandoli GE, Sisti N, D'Ascenzi F, Focardi M, Bernazzali S, Vergaro G, Emdin M, Valente S, Cameli M. The role of non-invasive imaging modalities in cardiac allograft vasculopathy: an updated focus on current evidences. Heart Fail Rev 2021; 27:1235-1246. [PMID: 34383194 PMCID: PMC9197817 DOI: 10.1007/s10741-021-10155-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse form of vasculopathy affecting almost 50% of patients after 10 years from heart transplant and represents the most common cause of long-term cardiovascular mortality among heart transplant recipients. The gold standard diagnostic technique is still invasive coronary angiography, which however holds potential for complications, especially contrast-related kidney injury and procedure-related vascular lesions. Non-invasive and contrast-sparing imaging techniques have been advocated and investigated over the past decades, in order to identify those that could replace coronary angiography or at least reach comparable accuracy in CAV detection. In addition, they could help the clinician in defining optimal timing for invasive testing. This review attempts to examine the currently available non-invasive imaging techniques that may be used in the follow-up of heart transplant patients, spanning from echocardiography to nuclear imaging, cardiac magnetic resonance and cardiac computed tomography angiography, weighting their advantages and disadvantages.
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Affiliation(s)
- C Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy.
| | - N Ghionzoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - G E Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - N Sisti
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - F D'Ascenzi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Focardi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - S Bernazzali
- Department of Cardiac Surgery, University Hospital of Siena, Siena, Italy
| | - G Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Valente
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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6
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Quantitative cardiac magnetic resonance T2 imaging offers ability to non-invasively predict acute allograft rejection in children. Cardiol Young 2020; 30:852-859. [PMID: 32456723 PMCID: PMC7654096 DOI: 10.1017/s104795112000116x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Monitoring for acute allograft rejection improves outcomes after cardiac transplantation. Endomyocardial biopsy is the gold standard test defining rejection, but carries risk and has limitations. Cardiac magnetic resonance T2 mapping may be able to predict rejection in adults, but has not been studied in children. Our aim was to evaluate T2 mapping in identifying paediatric cardiac transplant patients with acute rejection. METHODS Eleven paediatric transplant patients presenting 18 times were prospectively enrolled for non-contrast cardiac magnetic resonance at 1.5 T followed by endomyocardial biopsy. Imaging included volumetry, flow, and T2 mapping. Regions of interest were manually selected on the T2 maps using the middle-third technique in the left ventricular septal and lateral wall in a short-axis and four-chamber slice. Mean and maximum T2 values were compared with Student's t-tests analysis. RESULTS Five cases of acute rejection were identified in three patients, including two cases of grade 2R on biopsy and three cases of negative biopsy treated for clinical symptoms attributed to rejection (new arrhythmia, decreased exercise capacity). A monotonic trend between increasing T2 values and higher biopsy grades was observed: grade 0R T2 53.4 ± 3 ms, grade 1R T2 54.5 ms ± 3 ms, grade 2R T2 61.3 ± 1 ms. The five rejection cases had significantly higher mean T2 values compared to cases without rejection (58.3 ± 4 ms versus 53 ± 2 ms, p = 0.001). CONCLUSIONS Cardiac magnetic resonance with quantitative T2 mapping may offer a non-invasive method for screening paediatric cardiac transplant patients for acute allograft rejection. More data are needed to understand the relationship between T2 and rejection in children.
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Zhu S, Li M, Tian F, Wang S, Li Y, Yin P, Zhang L, Xie M. Diagnostic value of myocardial strain using two-dimensional speckle-tracking echocardiography in acute cardiac allograft rejection: A systematic review and meta-analysis. Echocardiography 2020; 37:561-569. [PMID: 32200582 DOI: 10.1111/echo.14637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/06/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Two-dimensional speckle-tracking echocardiography (2D STE) has been demonstrated to have certain diagnostic utility in heart transplantation (HTX) patients with acute cardiac allograft rejection (ACAR). The aim of the systematic review and meta-analysis was to evaluate the diagnostic value of common strain parameters for ACAR in HTX patients. METHODS After conducting a database search, we selected studies evaluating left ventricular global longitudinal strain (GLS), circumferential strain (CS), radial strain (RS), and free wall right ventricular longitudinal strain (RV FW) in rejection group vs rejection-free group. RESULTS After reviewing 886 publications, seven studies were finally included in the meta-analysis, representing the data of 1173 pairs of endomyocardial biopsy and echocardiographic examination. Heart transplantation patients with rejection had significantly lower GLS than rejection-free subjects (weighted mean difference -2.32 (95% CI, -3.41 to -1.23; P < .001). Heart transplantation patients with rejection had significantly lower CS than rejection-free subjects (weighted mean difference -2.49 (95% CI, -4.05 to -0.91; P = .0019). In addition, HTX patients with rejection also had significantly lower RV FW (weighted mean difference -4.90 (95% CI, -6.15 to -3.65; P < .001). CONCLUSIONS The meta-analysis and systematic review demonstrate that myocardial strain parameters derived from 2D STE may be useful in detecting ACAR in HTX patients. The present results provide encouraging evidence to consider the routine use of GLS, CS, and RV FW as markers of graft function involvement during ACAR.
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Affiliation(s)
- Shuangshuang Zhu
- 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
| | - Fangyan Tian
- 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
| | - Shuyuan 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
| | - 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
| | - Ping Yin
- Epidemiology and Health Statistics, Tongji Medical College, Huazhong University of Science and Technology, 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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8
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White BR, Katcoff H, Faerber JA, Lin KY, Rossano JW, Mercer-Rosa L, O'Connor MJ. Echocardiographic Assessment of Right Ventricular Function in Clinically Well Pediatric Heart Transplantation Patients and Comparison With Normal Control Subjects. J Am Soc Echocardiogr 2019; 32:537-544.e3. [PMID: 30954122 DOI: 10.1016/j.echo.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiographic follow-up after pediatric heart transplantation is important because of the lifelong risk for rejection and resultant ventricular dysfunction. Although adult studies have shown that echocardiographic measures of right ventricular function are changed after transplantation, similar results have not been reported in the pediatric population. METHODS A single-center retrospective study of echocardiograms obtained among pediatric heart transplant recipients was conducted. All echocardiograms were selected remote from transplantation, rejection, or graft vasculopathy. These criteria identified 127 patients. Right ventricular systolic function was measured using tricuspid annular plane systolic excursion, fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S'). Results were compared with those in 380 healthy age-matched echocardiographic control subjects. RESULTS Tricuspid annular plane systolic excursion values in pediatric heart transplant recipients were significantly lower than in control subjects at all ages (P < .0001), with a mean Z score of -3.38. FAC and S' did not vary by age in control patients >6 months of age. FAC values in transplantation patients were significantly decreased compared with those in control subjects (P < .0001), but 83% of transplantation patients had FAC values within the control-derived normal range. S' values were also significantly lower in transplantation patients than control subjects (P < .0001). CONCLUSIONS Heart transplantation patients have significantly decreased quantitative metrics of right ventricular function relative to healthy control subjects; longitudinal shortening (tricuspid annular plane systolic excursion and S') is particularly affected. FAC is relatively preserved and may be a better metric in this population. These results establish nomograms of RV function in pediatric heart transplantation patients and in normal pediatric control subjects, which may allow quantification of changes in this vulnerable population.
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Affiliation(s)
- Brian R White
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Hannah Katcoff
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer A Faerber
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Y Lin
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph W Rossano
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Post-transplant surveillance for acute rejection and allograft vasculopathy by echocardiography: Usefulness of myocardial velocity and deformation imaging. J Heart Lung Transplant 2017; 36:117-131. [DOI: 10.1016/j.healun.2016.09.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/18/2022] Open
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10
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Payne GA, Hage FG, Acharya D. Transplant allograft vasculopathy: Role of multimodality imaging in surveillance and diagnosis. J Nucl Cardiol 2016; 23:713-27. [PMID: 26711101 DOI: 10.1007/s12350-015-0373-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/27/2015] [Indexed: 01/22/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is a challenging long-term complication of cardiac transplantation and remains a leading long-term cause of graft failure, re-transplantation, and death. CAV is an inflammatory vasculopathy distinct from traditional atherosclerotic coronary artery disease. Historically, the surveillance and diagnosis of CAV has been dependent on serial invasive coronary angiography with intravascular imaging. Although commonly practiced, angiography is not without significant limitations. Technological advances have provided sophisticated imaging techniques for CAV assessment. It is now possible to assess the vascular lumen, vessel wall characteristics, absolute blood flow, perfusion reserve, myocardial contractile function, and myocardial metabolism and injury in a noninvasive, expeditious manner with little risk. The current article will review key imaging modalities for the surveillance, diagnosis, and prognosis of CAV and discuss coronary physiology of transplanted hearts with emphasis on the clinical implications for provocative and vasodilator stress testing.
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Affiliation(s)
- Gregory A Payne
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Deepak Acharya
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA.
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11
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12
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Optimizing Noninvasive Approaches to Rejection Surveillance in Cardiac Allograft Recipients. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Gupta B, Jacob D, Thompson R. Imaging in patients after cardiac transplantation and in patients with ventricular assist devices. J Nucl Cardiol 2015; 22:617-38. [PMID: 25832983 DOI: 10.1007/s12350-015-0115-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/29/2015] [Indexed: 02/06/2023]
Abstract
The field of cardiac imaging and the management of patients with severe heart failure have advanced substantially during the past 10 years. Cardiac transplantation offers the best long-term survival with high quality of life for the patients with end stage heart failure. However, acute cardiac rejection and cardiac allograft vasculopathy (CAV) can occur post cardiac transplantation and these problems necessitate regular surveillance. The short-term success of mechanical circulatory support devices (MCSD), such as ventricular assist devices (VADs), in improving survival and quality of life has led to a dramatic growth of the patient population with these devices. The development of optimal imaging techniques and algorithms to evaluate these advanced heart failure patients is evolving and multimodality non-invasive imaging approaches and invasive techniques are commonly employed. Most of the published studies done in the transplant and VAD population are small, and biased based on the strength of the particular program, and there is a relative lack of published protocols to evaluate these patient groups. Moreover, the techniques of echocardiography, computed tomography (CT), magnetic resonance imaging, and nuclear cardiology have all progressed rapidly in recent years. There is thus a knowledge gap for cardiologists, radiologists, and clinicians, especially regarding surveillance for CAV and ideal imaging approaches for patients with VADs. The purpose of this review article is to provide an overview of different noninvasive imaging modalities used to evaluate patients after cardiac transplantation and for patients with VADs. The review focuses on the role of echocardiography, CT, and nuclear imaging in surveillance for CAV and rejection and on the assessment of ventricular structure and function, myocardial remodeling and complications for VAD patients.
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Affiliation(s)
- Bhanu Gupta
- Department of Cardiology, St. Luke's Mid America Heart Institute, 4330 Wornall Rd, Suite 2000, Kansas City, MO, USA
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14
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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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15
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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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Winstead KB, Arora H, Kumar PA. An unusual finding after cardiac transplantation. J Cardiothorac Vasc Anesth 2012; 27:404-5. [PMID: 22449403 DOI: 10.1053/j.jvca.2012.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine B Winstead
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599-7010, USA
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Estep JD, Shah DJ, Nagueh SF, Mahmarian JJ, Torre-Amione G, Zoghbi WA. The role of multimodality cardiac imaging in the transplanted heart. JACC Cardiovasc Imaging 2009; 2:1126-40. [PMID: 19761994 DOI: 10.1016/j.jcmg.2009.06.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 06/19/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
Abstract
Heart transplantation (HT) is an established life-saving treatment option for patients with end-stage heart failure. Despite many advances in the field, the development of acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV) represent significant causes of 1- and 5-year morbidity and mortality, respectively. The search for noninvasive techniques to assess cardiac allograft function and detect treatable ACR and CAV remains a priority objective for heart transplant professionals. In this review we will: 1) highlight the clinical significance of ACR and CAV in adult cardiac transplant recipients and 2) discuss how different noninvasive imaging modalities (echocardiography, cardiac computed tomography, myocardial perfusion imaging, and cardiac magnetic resonance) have been used in the evaluation of these clinical challenges after HT.
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Affiliation(s)
- Jerry D Estep
- Department of Cardiology, Section of Heart Failure and Heart Transplantation, and Cardiovascular Imaging Institute, Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA.
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Emergency Department Presentation of Heart Transplant Recipients with Acute Heart Failure. Heart Fail Clin 2009; 5:129-43, viii. [DOI: 10.1016/j.hfc.2008.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mondillo S, Maccherini M, Galderisi M. Usefulness and limitations of transthoracic echocardiography in heart transplantation recipients. Cardiovasc Ultrasound 2008; 6:2. [PMID: 18190712 PMCID: PMC2249582 DOI: 10.1186/1476-7120-6-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Accepted: 01/11/2008] [Indexed: 11/26/2022] Open
Abstract
Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state, endocardial myocardial biopsies are still regarded as the gold standard for detection of acute allograft rejection. Conversely, stress echocardiography is able to identify accurately cardiac graft vasculopathy and has a recognised prognostic in this clinical setting. A normal stress-echo justifies postponement of invasive studies. Another use of transthoracic echocardiography is the monitorisation and the visualisation of the catheter during the performance of endomyocardial biopsy. Bedside stress echocardiography is even useful to select appropriately heart donors with brain death. The ultrasound monitoring is simple and effective for monitoring a safe performance of biopsy procedures.
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Affiliation(s)
- Sergio Mondillo
- Cardiologia Universitaria, Università di Siena, Siena, Italy.
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