Key result
Higher grades of asymptomatic acute cellular rejection were associated with significantly lower average radial strain (29.1%, 23.2%, and 14.3% for grades 0R, 1R, and 2R; P=0.001).
Why the study?
Does two-dimensional speckle tracking echocardiography detect asymptomatic acute cellular rejection in heart transplant recipients?
Observational (n=34)
Does two-dimensional speckle tracking echocardiography detect asymptomatic acute cellular rejection in heart transplant recipients?
p-value: p=0.001
Two-dimensional speckle tracking echocardiography, specifically average radial strain, can detect asymptomatic acute cellular rejection in heart transplant recipients with high sensitivity and negative predictive value.
BACKGROUND: Our objective was to evaluate the impact of asymptomatic acute cellular rejection (ACR) in left ventricular myocardial strain in heart transplant (HT) recipients by means of two-dimensional speckle tracking echocardiography (2DSTE). METHODS: From September 1, 2009 to December 15, 2010 a conventional echocardiography and 2DSTE exam was performed on all consecutive HT recipients in their first year posttransplantation within 3 hours of the surveillance endomyocardial biopsies, as well as on 14 healthy controls. The association of strain echocardiographic variables with different grades of ACR was investigated. RESULTS: Of the 78 studies performed 4 ± 3 months after HT in 20 patients, 32 studies were coincident with grade 0R rejection, 41 with grade 1R, and 5 with grade 2R. Significantly lower values of average radial strain were found with higher grades of ACR (29.1 ± 7.7%, 23.2 ± 8.5%, and 14.3 ± 8.8% for grades 0R, 1R, and 2R of ACR, P = 0.001). Average deformation was similar for controls versus transplanted patients, in the absence of acute rejection: radial 29.1 ± 10.0% versus 29.1 ± 7.7%, P = 0.98; circumferential -19.3 ± 3.2% versus -20.2 ± 5.9%, P = 0.62; and longitudinal -20.7 ± 4.1% versus -18.5 ± 5.4%, P = 0.19. An average radial strain <25% presented 100% sensitivity, 48% specificity, 6% positive predictive value, and 100% negative predictive value for the presence of 2R rejection (area under the curve 0.80, IC 95% 0.60-0.99, P = 0.048). CONCLUSION: In this study, HT recipients showed significantly lower values of average radial left ventricle strain, evaluated by means of 2DSTE, with the presence of ACR.
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Ortiz et al. (2014) conducted an observational in Heart transplant (n=34). Asymptomatic acute cellular rejection vs. Absence of acute rejection (Grade 0R) or healthy controls was evaluated on Average radial strain across grades of acute cellular rejection (p=0.001). Higher grades of asymptomatic acute cellular rejection were associated with significantly lower average radial strain (29.1%, 23.2%, and 14.3% for grades 0R, 1R, and 2R; P=0.001).
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