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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 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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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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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Sciaccaluga C, Natali BM, Righini FM, Sorini Dini C, Landra F, Mandoli GE, Sisti N, Menci D, D'Errico A, D'Ascenzi F, Focardi M, Bernazzali S, Maccherini M, Valente S, Cameli M. Heart transplantation and anti-HLA antibodY: myocardial dysfunction and prognosis - HeartLAy study. ESC Heart Fail 2023; 10:2853-2864. [PMID: 37415291 PMCID: PMC10567642 DOI: 10.1002/ehf2.14442] [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] [Received: 04/29/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
AIMS The presence of anti-human leucocyte antigen (HLA) antibodies has been implicated in a higher incidence of complications as well as mortality rate in heart transplantation. The aim of the study was to identify through non-invasive parameters early signs of myocardial dysfunction in the presence of anti-HLA antibodies but without evidence of antibody-mediated rejection (AMR) and its possible prognostic impact. METHODS AND RESULTS A total of 113 heart-transplanted patients without acute cellular rejection (ACR) and AMR or cardiac allograft vasculopathy (CAV) were prospectively enrolled and divided into two groups ['HLA+' (50 patients) and 'HLA-' (63 patients)], based on the presence of anti-HLA antibodies. Each patient was followed for 2 years after the enrolment, recording episodes of AMR, ACR, CAV, and mortality. Clinical characteristics were similar between the two groups. Among laboratory data, N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin values were significantly higher in the presence of anti-HLA antibodies (P < 0.001 and P = 0.003, respectively). The echocardiographic parameters that showed a statistically significant difference between the two groups were deceleration time of E wave (DecT E, P < 0.001), left ventricular global longitudinal strain (P < 0.001), tricuspid annular plane systolic excursion (P = 0.011), tricuspid S' wave (P = 0.002), and free wall right ventricular longitudinal strain (fwRVLS, P = 0.027), whereas left atrial strain did not differ significantly (P = 0.408). Univariate analysis showed that anti-HLA antibodies were associated with the development of CAV at both 1 and 2 year follow-up [odds ratio (OR) 11.90, 95% confidence interval (CI) 1.43-90.79, P = 0.022 and OR 3.37, 95% CI 1.78-9.67, P = 0.024, respectively]. Bivariate analysis demonstrated that both fwRVLS and DecT E were predictors of CAV development independently from HLA status. CONCLUSIONS The presence of circulating anti-HLA antibodies is correlated with a mild cardiac dysfunction, even in the absence of AMR, and CAV development. Interestingly, reduced values of DecT E and fwRVLS were predictors of future development of CAV, independently from anti-HLA antibody.
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Affiliation(s)
- Carlotta Sciaccaluga
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Benedetta Maria Natali
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | - Carlotta Sorini Dini
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Federico Landra
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Nicolò Sisti
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Daniele Menci
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Marta Focardi
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | | | - Serafina Valente
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
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Zhou L, Wolfson A, Vaidya AS. Noninvasive methods to reduce cardiac complications postheart transplant. Curr Opin Organ Transplant 2022; 27:45-51. [PMID: 34907978 DOI: 10.1097/mot.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Long-term success of heart transplantation is limited by allograft rejection and cardiac allograft vasculopathy (CAV). Classic management has relied on frequent invasive testing to screen for early features of rejection and CAV to allow for early treatment. In this review, we discuss new developments in the screening and prevention of allograft rejection and CAV. RECENT FINDINGS Newer noninvasive screening techniques show excellent sensitivity and specificity for the detection of clinically significant rejection. New biomarkers and treatment targets continue to be identified and await further studies regarding their utility in preventing allograft vasculopathy. SUMMARY Noninvasive imaging and biomarker testing continue to show promise as alternatives to invasive testing for allograft rejection. Continued validation of their effectiveness may lead to new surveillance protocols with reduced frequency of invasive testing. Furthermore, these noninvasive methods will allow for more personalized strategies to reduce the complications of long-term immunosuppression whereas continuing the decline in the overall rate of allograft rejection.
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Affiliation(s)
- Leon Zhou
- Department of Cardiology, Keck School of Medicine, Los Angeles, California, USA
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Sharma D, Subramaniam G, Sharma N, Sharma P, Sharma P. Insight into Noninvasive Radiological Modalities to Detect Heart Transplant Rejection. Indian J Radiol Imaging 2022; 31:946-955. [PMID: 35136508 PMCID: PMC8817810 DOI: 10.1055/s-0041-1741098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Purpose Patients with end-stage heart failure who remain symptomatic even with exemplary medical and device therapy are treated with heart transplantation. Multitudes of endeavor have been contrived during the last decennium in the field of noninvasive tests to rule out heart transplant rejection (HTR). In spite of having supportive literature, noninvasive imaging techniques lack acceptable documentation of clinical robustness, and endomyocardial biopsy (EMB) still remains the gold standard. The aim of this review is to shed light on the existing noninvasive radiological modalities to detect rejection among heart transplant recipients.
Methods A comprehensive search was conducted for this review article on the basis of literature available including scientific databases of PubMed, Embase, and Google Scholar, using keywords of “Heart transplantation,” “Acute allograft rejection,” “Arrhythmias,” “Echocardiography,” “Speckle tracking echocardiography,” and “Cardiac magnetic resonance imaging” from inception until September 2020.
Results After preliminary screening of the databases, details regarding existent noninvasive radiological modalities to detect HTR were gathered and compiled in this review article. Currently, deformation imaging using speckle tracking and T2 time using cardiac magnetic resonance imaging can serve as screening tools based on which further invasive investigations can be planned. Standardization of blood-based and imaging modalities as screening and possible diagnostic tools for rejection would have obvious clinical and financial benefits in the care of growing number of post heart transplant recipients in our country.
Conclusion Diagnosis of allograft rejection in heart transplant recipients through noninvasive techniques is demanding. To unravel the potential of noninvasive radiological modalities that can serve as a standard-of-care test, a prospective multicentric study randomizing noninvasive modality as first strategy versus current EMB-based gold standard of care is the need of the hour.
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Affiliation(s)
- Dhruva Sharma
- Department of Cardiothoracic and Vascular Surgery, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Ganapathy Subramaniam
- Department of Cardiothoracic Surgery, Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Neha Sharma
- Department of Pharmacology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Preksha Sharma
- Department of Anatomy, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Pooja Sharma
- Department of Cardiology, Eternal Heart Care Centre, Jaipur, Rajasthan, India
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Ungerman E, Jayaraman AL, Patel B, Khoche S, Subramanian H, Bartels S, Knight J, Gelzinis TA. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2020 Part II: Cardiac Transplantation. J Cardiothorac Vasc Anesth 2021; 36:390-402. [PMID: 34657796 DOI: 10.1053/j.jvca.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Ungerman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Arun L Jayaraman
- Department of Anesthesiology and Perioperative Medicine, Department of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Bhoumesh Patel
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Swapnil Khoche
- Department of Anesthesiology, University of California, San Diego, CA
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven Bartels
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, IL
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
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Bacal DC, Fernandes-Silva MM, Mangini S, de Jesus MS, Bacal F. C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant. Clinics (Sao Paulo) 2021; 76:e3020. [PMID: 34878028 PMCID: PMC8610219 DOI: 10.6061/clinics/2021/e3020] [Citation(s) in RCA: 1] [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] [Received: 04/24/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function. METHODS We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis. RESULTS We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, p<0.05). The only independent predictors that remained in the model were CRP level and LV mass index. The optimal cut-off point for CRP level was ≥15.9 mg/L (odds ratio [OR], 11.7; p=0.007) and that for LV mass index was ≥111 g/m2 (OR, 13.6; p=0.003). The area under the receiver operating characteristic curve derived from this model was 0.87 (95% confidence interval [CI], 0.75-0.99), with sensitivity of 85.7% (95% CI, 42.1%-99.6%), specificity of 78.4% (95% CI, 64.7%-88.7%), positive predictive value of 35.3% (95% CI, 14.3%-61.7%), and negative predictive value of 97.6% (95% CI, 87.1%-99.9%). CONCLUSIONS Among patients undergoing HT, CRP level and LV mass were directly associated with ACR, but troponin and BNP levels were not.
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Affiliation(s)
- Débora Cestari Bacal
- Programa de Transplante Cardiaco, Hospital Israelita Albert Einstein (HIAE), Sao Paulo, SP, BR
| | | | - Sandrigo Mangini
- Programa de Transplante Cardiaco, Hospital Israelita Albert Einstein (HIAE), Sao Paulo, SP, BR
| | - Marcia Santos de Jesus
- Programa de Transplante Cardiaco, Hospital Israelita Albert Einstein (HIAE), Sao Paulo, SP, BR
| | - Fernando Bacal
- Programa de Transplante Cardiaco, Hospital Israelita Albert Einstein (HIAE), Sao Paulo, SP, BR
- Corresponding author. E-mails: /
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Non-invasive cardiac allograft rejection surveillance: reliability and clinical value for prevention of heart failure. Heart Fail Rev 2020; 26:319-336. [PMID: 32889634 DOI: 10.1007/s10741-020-10023-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 01/04/2023]
Abstract
Allograft rejection-related acute and chronic heart failure (HF) is a major cause of death in heart transplant recipients. Given the deleterious impact of late recognized acute rejection (AR) or non-recognized asymptomatic antibody-mediated rejection on short- and long-term allograft function improvement of AR surveillance and optimization of action strategies for confirmed AR can prevent AR-related allograft failure and delay the development of cardiac allograft vasculopathy, which is the major cause for HF after the first posttransplant year. Routine non-invasive monitoring of cardiac function can improve both detection and functional severity grading of AR. It can also be helpful in guiding the anti-AR therapy and timing of routine surveillance endomyocardial biopsies (EMBs). The combined use of EMBs with non-invasive technologies and methods, which allow detection of subclinical alterations in myocardial function (e.g., tissue Doppler imaging and speckle-tracking echocardiography), reveal alloimmune activation (e.g., screening of complement-activating donor-specific antibodies and circulating donor-derived cell-free DNA) and help in predicting the imminent risk of immune-mediated injury (e.g., gene expression profiling, screening of non-HLA antibodies, and circulating donor-derived cell-free DNA), can ensure the best possible surveillance and management of AR. This article gives an overview of the current knowledge about the reliability and clinical value of non-invasive cardiac allograft AR surveillance. Particular attention is focused on the potential usefulness of non-invasive tools and techniques for detection and functional grading of early and late ARs in asymptomatic patients. Overall, the review aimed to provide a theoretical and practical basis for those engaged in this particularly demanding up-to-date topic.
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Sabour S. Myocardial strain using two-dimensional speckle-tracking echocardiography in acute cardiac allograft rejection: Methodological issues on diagnostic value. Echocardiography 2020; 37:982-983. [PMID: 32472592 DOI: 10.1111/echo.14741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Siamafk Sabour
- Department of Clinical Epidemiology, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Safety Promotions and Injury Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Zhu S, Zhang L, Xie M. In Reply to the Letter to the Editor Regarding "Myocardial strain using two-dimensional speckle-tracking echocardiography in acute cardiac allograft rejection: Methodological issues on diagnostic value". Echocardiography 2020; 37:984-985. [PMID: 32463136 DOI: 10.1111/echo.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022] Open
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
| | - 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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