Establishing baseline global longitudinal strain values in heart transplant recipients

Global longitudinal strain (GLS) is increasingly recognized as a sensitive marker of subtle myocardial dysfunction in heart transplant recipients, yet standardized reference trends and their clinical implications remain underreported. To evaluate serial changes in GLS during the first year post-heart transplantation and explore its association with donor ischemic time and histopathological rejection grades. In this retrospective cohort study, we analyzed serial transthoracic echocardiograms of 85 heart transplant recipients at our center. GLS was measured at baseline (post-operative), 3, 6, and 12 months using vendor-independent speckle-tracking software. Correlations with donor ischemic time and biopsy-proven rejection (≥ ISHLT grade 2R) were assessed. Mean GLS showed a gradual improvement from − 12.1 ± 2.8% immediately post-transplant to − 15.6 ± 2.5% at one year, while left ventricular ejection fraction (LVEF) remained within normal limits throughout follow-up. Longer donor ischemic time (> 180 min) was significantly associated with persistently lower GLS (p < 0.01). Higher rejection grades correlated with transient GLS worsening despite stable LVEF (p < 0.05). This real-world study provides reference serial GLS values after heart transplantation, highlighting its added sensitivity over conventional LVEF for detecting subtle graft dysfunction and its potential role in guiding biopsy frequency. Integration of GLS monitoring may help personalize surveillance and improve long-term graft outcomes.