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Edvi B, Assabiny A, Teszák T, Tolvaj M, Fábián A, Hartyánszky I, Pólos M, Lakatos BK, Vágó H, Sax B, Merkely B, Kovács A. Trajectory of Diastolic Function after Heart Transplantation as Assessed by Left Atrial Deformation Analysis. Diagnostics (Basel) 2024; 14:1136. [PMID: 38893661 PMCID: PMC11171485 DOI: 10.3390/diagnostics14111136] [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: 04/30/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Diastolic dysfunction (DD) is a prevalent and clinically significant complication after heart transplantation (HTX). We aimed to characterize the diastolic function of HTX recipients with both short-term and long-term follow-ups by applying left atrial (LA) deformation analysis. We consecutively enrolled and followed up with 33 HTX patients. Three assessments were performed one month, 3-5 months, and 3-5 years after surgery. Beyond conventional echocardiographic measurements, apical four-chamber views optimized for speckle tracking analysis were acquired and post-processed by dedicated software solutions (TomTec AutoStrain LA and LV). Left atrial phasic functions were characterized by reservoir, conduit, and contraction strains. We categorized diastolic function according to current guidelines (normal diastolic function, indeterminate, DD). At the first assessment, nine (27%) patients were in the DD category, and eleven (33%) were indeterminate. At the second assessment, only one patient (3%) remained in the DD category and six (18%) were indeterminate. At the third assessment, 100% of patients were categorized as having normal diastolic function. LA reservoir strain gradually increased over time. LA contraction strain significantly improved from the second to the third assessment. We found a correlation between the LA reservoir strain and NT-proBNP (r = 0.40, p < 0.05). DD is prevalent immediately after HTX but rare until the end of the first postoperative quarter. Speckle tracking analysis enables the characterization of LA phasic functions that may reflect both short- and long-term changes in diastolic function and correlate with NT-proBNP.
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Affiliation(s)
- Borbála Edvi
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Alexandra Assabiny
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Tímea Teszák
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Máté Tolvaj
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - István Hartyánszky
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | | | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Balázs Sax
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary (T.T.)
- Department of Experimental Cardiology and Surgical Techniques, Semmelweis University, H-1122 Budapest, Hungary
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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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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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Zhu V, Perry LA, Plummer M, Segal R, Smith J, Liu Z. Diagnostic accuracy of brain natriuretic peptide and N-terminal-pro brain natriuretic peptide to detect complications of cardiac transplantation in adults: A systematic review and meta-analysis. Transplant Rev (Orlando) 2023; 37:100774. [PMID: 37433240 DOI: 10.1016/j.trre.2023.100774] [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: 04/17/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND We aimed to evaluate the utility of BNP and NT-proBNP in identifying adverse recipient outcomes following cardiac transplantation. METHODS We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from inception to February 2023. We included studies reporting associations between BNP or NT-proBNP and adverse outcomes following cardiac transplantation in adults. We calculated standardised mean differences (SMD) with 95% confidence intervals (CI); or confusion matrices with sensitivities and specificities. Where meta-analysis was inappropriate, studies were analysed descriptively. RESULTS Thirty-two studies involving 2,297 cardiac transplantation recipients were included. We report no significant association between BNP or NT-proBNP and significant acute cellular rejection of grade 3A or higher (SMD 0.40, 95% CI -0.06-0.86) as defined by the latest 2004 International Society for Heart and Lung Transplantation Guidelines. We also report no strong associations between BNP or NT-proBNP and cardiac allograft vasculopathy or antibody mediated rejection. CONCLUSION In isolation, serum BNP and NT-proBNP lack sufficient sensitivity and specificity to reliably predict adverse outcomes following cardiac transplantation.
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Affiliation(s)
- Victor Zhu
- Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.
| | - Luke A Perry
- Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Mark Plummer
- Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; Department of Intensive Care Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Reny Segal
- Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Julian Smith
- Department of Surgery, Monash University, Clayton, Australia
| | - Zhengyang Liu
- Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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5
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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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Hayward C. Cardiac Allograft Injuries: A Review of Approaches to a Common Dilemma, With Emphasis on Emerging Techniques. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:123-135. [PMID: 36262796 PMCID: PMC9383355 DOI: 10.36628/ijhf.2021.0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Clinical features of allograft injury are often unreliable, and context within the transplant journey is key. In the setting of post-transplant allograft dysfunction, the choice of initial investigation depends on clinical assessment and history. One of the major considerations is the time post transplantation in helping to decide a likely cause for allograft injury. Immediately post transplantation, it is important to consider donor factors (including donor demographics as well as immunological match), ischaemic times, surgical issues as well as early rejection. Clinical suspicion needs to remain high with variable presentations, including haemodynamic instability, arrhythmia, as well as left ventricular dysfunction. Symptoms of allograft dysfunction may include dyspnoea, exertional intolerance, dizziness / lightheadedness, palpitations, as well as right or left heart failure. In the coming weeks and months, endomyocardial biopsy and blood-based biomarkers may be helpful including high sensitivity troponin and donor-derived cell-free DNA. Molecular markers for rejection are hopeful, and may also be useful in non-ischaemic causes of allograft dysfunction. Screening remains important late post heart transplant due to variety of signs associated with rejection (early) and lack of typical anginal symptoms (later). New imaging modalities - especially cardiac magnetic resonance imaging, have been shown to be useful for assessing cause of allograft dysfunction including ischemia, infarction and rejection.
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Affiliation(s)
- Christopher Hayward
- Department of Cardiology, St Vincent’s Hospital, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
- University of New South Wales, Sydney, Australia
- University of Technology Sydney, Sydney, Australia
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7
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Otto MEB, Martins AMA, Campos Dall’Orto ADOM, Leite SF, de Queiroz Mauricio Filho MAF, Martins NT, de Araújo SR, Almeida SV, Paiva MUB, Atik FA. Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease. Front Cardiovasc Med 2022; 9:841698. [PMID: 35571160 PMCID: PMC9091442 DOI: 10.3389/fcvm.2022.841698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Echocardiographic markers associated with asymptomatic acute cellular rejection (ACR) in patients with orthotopic heart transplant (HT) are still under investigation. The aim of our study was to determine clinical and myocardial strain imaging (MSI) variables evaluated by echocardiography associated with ACR in the first year of HT. A separate analysis was performed to compare variables during the first 6 months of HT, when ACR has a prevalence in 60% of patients. Another analysis evaluated an exclusive population with Chagas disease as the cause of HT. Methods We prospectively studied 67 patients with less than 1 year of HT, 36 patients without ACR (41% men, age 49 ± 12 years, 52% Chagas disease as the cause of heart failure), and 31 patients with ACR (59% men, age 55 ± 8 years, 74% Chagas disease as the cause of heart failure). Conventional echocardiographic measurements and MSI by global longitudinal strain (GLS) from the left ventricle (LV) and right ventricle free wall (RV-FWLS) and myocardial work (MW) from the left ventricle were obtained by experienced echocardiologists. Clinical variables, such as the presence of diabetes, hypertension, and immunosuppressant drugs, were compared between groups. Results HT patients with ACR were older and used more cyclosporine for immunosuppression. The positive ACR group had an increased relative wall thickness and LV mass index and similar LVGLS and RV-FWLS compared to the negative ACR group. Nevertheless, MW analysis observed increased global work efficiency (GWE) in positive ACR. Multivariate analysis identified older age, cyclosporine use, LV mass index, and GWE as independent predictors for detecting rejection. A separate analysis was performed for patients with less than 6 months of HT. Similar MSI was observed in both groups, with a trend for increased GWE in patients with ACR and significantly increased LV mass index in the ACR group. An exclusive group of Chagas patients as the primary cause of HT was analyzed, and similar MSI results for LVGLS, RV-FWLS, and MW were observed for both ACR and the no rejection groups. Additionally, the survival rates at 2 years were similar between the Chagas disease groups. Conclusion LVGLS and RV-FWLS were similar between patients with or without ACR in the first year after HT. Conversely, GWE, a derivative of LVGLS, and LV mass index were increased in positive ACR and could be markers for rejection. Increased LV mass index was also found in a subgroup analysis of patients less than 6 months after HT; however, MSI was similar regardless of ACR. For chagasic patients, rejection in the first year did not increase mortality at the 2-year follow-up, and MSI parameters were similar between patients with or without ACR. In a multivariate analysis to predict ACR, the independent parameters in this study were older age, cyclosporine use, LV mass index, and GWE.
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Affiliation(s)
- Maria Estefânia Bosco Otto
- Cardiology and Transplant Heart Institute, Brasília, Brazil,*Correspondence: Maria Estefânia Bosco Otto,
| | | | | | | | | | | | | | | | | | - Fernando Antibas Atik
- Cardiology and Transplant Heart Institute, Brasília, Brazil,School of Medicine, University of Brasilia, Brasília, Brazil
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8
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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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9
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Cruz CBBV, Hajjar LA, Bacal F, Lofrano-Alves MS, Lima MSM, Abduch MC, Vieira MLC, Chiang HP, Salviano JBC, da Silva Costa IBS, Fukushima JT, Sbano JCN, Mathias W, Tsutsui JM. Correction to: Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation. Cardiovasc Ultrasound 2021; 19:12. [PMID: 33509186 PMCID: PMC7844959 DOI: 10.1186/s12947-021-00241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cecilia Beatriz Bittencourt Viana Cruz
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil. .,Fleury Medicine & Health, São Paulo, Brazil.
| | - Ludhmila A Hajjar
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Fernando Bacal
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Marco S Lofrano-Alves
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Márcio S M Lima
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Maria C Abduch
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Marcelo Luiz Campos Vieira
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Hsu P Chiang
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Juliana B C Salviano
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | | | - Julia Tizue Fukushima
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Joao C N Sbano
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas, de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
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