Utility of left ventricular systolic strain, strain rate and torsion imaging derived from speckle-tracking echocardiography in monitoring mild acute cellular rejection in heart transplant recipients
Bildiriler > Özet Bildiri
Yazarlar: E. Simsek, Sanem NALBANTGİL, D. Nart, S. Kilic, M. Oylumlu, Çağatay ENGİN, T. Yagdi, Mustafa ÖZBARAN
European Heart Journal, , , Uluslararası, Özet Bildiri, Wos, cilt 34, ss P2170-P2170
DOI: 10.1093/eurheartj/eht308.p2170
Özet
Objective: Non-invasive diagnosis of the rejection is a major objective in the management of heart transplant recipients. There are a few studies about strain, strain rate and torsion imaging derived from 2 dimensional speckle tracking echocardiography in monitoring acute cellular rejection in heart transplant patients. But in these studies old International Society of Heart and Lung Transplantation (ISHLT) EMBx cellular rejection classification was used and comparisons were done between patients had grade 1a plus no rejection and grade 1b plus grade 2 and 3. Our study is aimed to investigate ability of left ventricular torsion, strain and strain rate imaging by 2d echocaradiography to detect only mild (ISHLT grade 1R) rejection in heart transplant recipients Methods: 26 heart transplant recipients were investigated and in 6 hours period echocardiographies, endomyocardial biopsies and right heart catheterisations were performed. Mean values of peak systolic strain, strain rates obtained from twelve left ventricular segments and torsion values obtained from three planes of left ventricle in parasternal short axis. For rejection definition of endomyocardial biopsies ISHLT's newest EMBx acute cellular rejection classification is used. Results: 292 of the 312 segments analysed for strain- strain rate imaging and in 4 patients torsion values could not be obtained because of the resolution problems. 11 patients had grade 1R rejection (group II) and 15 patients had no rejection (Group I). Globally strain and strain rates were lower in group II but these were only statistically significant in strain values of interventricular septal wall basal (respectively for group I and II, -13,6±3,5 vs -10,6±3,2 and p=0,037), mid (-13,1±3,1 vs -9,8±2,6 and p=0,019), apical (-13,1±3,2 vs -9,6±3,7 and p=0,030) and lateral wall apical (-13±3,4 vs –8,6±5,5 p=0,028) segments. Although apical (5,1±4,9° vs 0,75±5,7° and p=0,106) and basal rotation (-4,8±3,6° vs -3,6±3,5° and p=0,373) were lover in group II, only decrease in torsion value (9,8±6,1° vs 4,4±3,4° and p= 0,023) was statistically significant. There were no difference in left ventricular ejection fractions, presence of coronary allograft vasculopathy, pulmonary capillary wedge pressures, transpulmonary gradients, systolic pulmonary artery pressure values between groups. Conclusion: Strain, strain rate and torsion imaging of the left ventricle by 2D echocardiography could be of clinical value in monitoring and diagnosing even mild acute rejection in heart transplant recipients and could improve patients' management by reducing the number of biopsies performed