Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(4):601-606 | DOI: 10.5507/bp.2015.020

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Helena Podrouzkova^a, Helena Bedanova^b, Martin Tretina^b, Josef Korinek^a,c, Radka Stepanova^d, Jana Hruskova^a, Petr Nemec^b, Tomas Konecny^a, Marek Orban^a,b

^a ICRC, St. Anne's University Hospital in Brno, Czech Republic

^b Center of Cardiovascular and Transplant Surgery, St. Anne's University Hospital in Brno

^c 2^nd Department of Internal Medicine - Cardiology and Angiology, General University Hospital and 1^st Faculty of Medicine, Charles University in Prague

^d Department of Biostatistics, ICRC, St. Anne's University Hospital in Brno

Background: Around 20-40% of heart transplant patients experience moderate to severe rejection within the first year after heart transplantation. Endomyocardial biopsy (EMB) is a gold standard for diagnosing heart transplant rejection. There is a need for non-invasive alternatives that allow for early, safe and reliable diagnosis of acute graft rejection prior to the onset of clinical symptoms.

Aims: Our aim was to investigate the potential of speckle tracking derived strain analysis in the diagnosis of acute graft rejection.

Methods: Patients indicated for EMB consented to a trans-thoracic echocardiography examination (TTE) within 2 hours of the EMB. Of this cohort, those with at least 2 EMBs separated ≥ 1 week, and whose TTE could be analyzed for strain, were included. The relationship between strain and EMB results was evaluated.

Results: Of the 43 patients included (mean age 51.33±1.79, 67% male), 23 had findings of rejection identified on at least one EMB and at least one EMB without rejection for comparison. A significant deterioration in the longitudinal strain during rejection compared to non-rejection was found on apical 4-chamber views (-11.51±0.91 vs -13.48±0.96, P=0.025) and apical 2-chamber views (-11.84±0.78 vs -14.43±0.83, P=0.002). In the patients in whom no rejection was identified on either EBM, there was no significant change in longitudinal strain values at two different time points.

Conclusion: Worsening of longitudinal strain was associated with acute cellular rejection. Routine TTE-based strain analysis could help in early detection of cardiac rejection and timing of EMB.

Keywords: echocardiography, heart transplantation, graft rejection

Received: August 4, 2014; Accepted: April 14, 2015; Prepublished online: April 29, 2015; Published: December 3, 2015  Show citation