Validation of the usefulness of 2-dimensional strain parameters to exclude acute rejection after heart transplantation: a multicenter study
Rev Esp Cardiol (Engl Ed). 2021 Apr;74(4):337-344.
doi: 10.1016/j.rec.2020.01.012.
Epub 2020 Mar 21.
[Article in
English,
Spanish]
Authors
Josebe Goirigolzarri Artaza
1
, Susana Mingo Santos
2
, José María Larrañaga
3
, Ana Osa
4
, Mario Sutil-Vega
5
, Martín Ruiz Ortiz
6
, Cecilia Corros
7
, Bárbara Vidal
8
, Vanessa Moñivas Palomero
2
, Nicolás Maneiro
3
, Cayetana María Barbeito
3
, Raquel López-Vilella
4
, Chi-Hion Li
5
, Sara Rodríguez Diego
6
, José Luis Lambert
7
, Franciris Velásquez
9
, María G Crespo-Leiro
10
, Luis Almenar
11
, Sonia Mirabet
5
, Alejandro Martínez Mingo
12
, Javier Segovia Cubero
13
Affiliations
- 1 Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. Electronic address: josebegoiri@gmail.com.
- 2 Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
- 3 Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Universidad de A Coruña, La Coruña, Spain.
- 4 Servicio de Cardiología, Hospital Universitario y Politécnico de La Fe, Valencia, Spain.
- 5 Servcio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB SantPau, Universidad Autónoma Barcelona, Barcelona, Spain.
- 6 Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain.
- 7 Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
- 8 Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto Carlos III, Madrid, Spain.
- 9 Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- 10 Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Universidad de A Coruña, La Coruña, Spain; Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto Carlos III, Madrid, Spain.
- 11 Servicio de Cardiología, Hospital Universitario y Politécnico de La Fe, Valencia, Spain; Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto Carlos III, Madrid, Spain.
- 12 Departamento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain.
- 13 Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto Carlos III, Madrid, Spain.
Abstract
Introduction and objectives:
Two-dimensional speckle-tracking echocardiography has emerged as a promising alternative to endomyocardial biopsy to rule out acute cellular rejection after orthotopic heart transplantation (OHT) in single center studies. In an original cohort, 15.5% and 17% of cutoff points for left ventricular global longitudinal strain (LVGLS) and free-wall right ventricular longitudinal strain, respectively, achieved 100% negative predictive value to exclude moderate or severe acute cellular rejection (ACR ≥ 2R). Our objective was to demonstrate the usefulness of speckle-tracking and validate these cutoff points in an external cohort.
Methods:
A prospective, multicenter study that included patients who were monitored during their first year after OHT was conducted. Echocardiographic studies analyzed by local investigators were compared with simultaneous paired endomyocardial biopsies samples.
Results:
A total of 501 endomyocardial biopsy-echocardiographic studies were included in 99 patients. ACR≥2R was present in 7.4% of samples. LVGLS and free-wall right ventricular longitudinal strain were significantly reduced during ACR≥2R on univariate analysis. On multivariate analysis, LVGLS was independently associated with the presence of ACR≥2R. The original cutoff points demonstrated a negative predictive value of 94.3% to exclude ACR≥2R.
Conclusions:
This study maintained a strong negative predictive value to exclude ACR≥2R after OHT and LVGLS was independently associated with the presence of ACR≥2R. We propose the use of speckle-tracking, especially LVGLS, as part of the noninvasive diagnosis and management of ACR.
Keywords:
Acute rejection; Heart transplantation; Rechazo agudo; Speckle-tracking; Strain; Trasplante cardiaco.
Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
MeSH terms
-
Echocardiography
-
Graft Rejection / diagnosis
-
Heart Transplantation*
-
Heart Ventricles / diagnostic imaging
-
Humans
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Prospective Studies