Key result
Combined troponin I and RV-FWLS detects post-transplant acute cellular rejection with an AUC of 0.89.
Why the study?
Endomyocardial biopsy is the gold standard for diagnosing acute cellular rejection after heart transplantation but has concerning complications.
Does the combination of speckle tracking echocardiography and biomarkers accurately detect acute cellular rejection in heart transplant patients?
Observational (n=120)
No
Does the combination of speckle tracking echocardiography and biomarkers accurately detect acute cellular rejection in heart transplant patients?
Effect estimate: AUC 0.89 (95% CI 0.81-0.93)
The combination of cardiac troponin I and speckle tracking echocardiography parameters, particularly right ventricular free wall longitudinal strain, provides high accuracy for detecting acute cellular rejection after heart transplantation.
BACKGROUND: Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation. METHODS: We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. RESULTS: Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 - 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09-1.31) vs 0.05 ng/mL (0.01-0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68-0.92), 0.89 (0.81-0.93) and 0.79 (0.66-0.92), respectively. CONCLUSION: Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.
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Cruz et al. (2021) conducted an observational in Heart transplantation (Acute cellular rejection) (n=120). Speckle tracking echocardiography and troponin I vs. Endomyocardial biopsy was evaluated on Detection of acute cellular rejection using combined troponin and right ventricular free wall longitudinal strain (RV-FWLS) (AUC 0.89, 95% CI 0.81-0.93). The combination of cardiac troponin I and right ventricular free wall longitudinal strain detected significant acute cellular rejection after heart transplantation with an area under the curve of 0.89.
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