Abstract
Denervation, pericardiotomy and immunosuppressant drugs may affect mechanical properties of the left ventricle (LV). We aimed to assess LV twist in heart transplant patients with normal LV ejection fraction (LVEF), and without or with mild acute rejection on cardiac biopsy. Twenty biopsies and echocardiographic studies were performed in 10 heart transplant patients (mean age: 40 ± 17 years) a median of 6 months after transplantation (range: 1 to 120 months). No patients had evidence of cardiac allograft vasculopathy. The mean age of the donor heart at the time of echocardiography was 37 ± 14 years. Routine endomyocardial biopsy was performed 24 hours after echocardiography. Ten age-matched controls (43 ± 15 years) were also studied. Short axis views were analyzed using speckle tracking software. LV twist was defined as the difference between the apical and basal rotation. Eight biopsies were on grade 0 (no rejection) and 12 on grade 1 R (mild rejection). The transplant groups and the control group did not differ in terms of LVEF (Grade 0: 66 ± 7%, grade 1R: 67 ± 11% and controls: 66 ± 6%) and in systolic mitral annular velocities (8.5 ± 1.6 cm/s, 7.7 ± 2.1 cm/s and 8.4 ± 1.4 cm/s, respectively, p = NS). Peak LV twist was reduced in patients with grade 0 and grade 1 R (6.0 ± 3.3° and 7.1 ± 3.6°, respectively) as compared to controls (12.1 ± 2.9°, p < 0.005 for both comparison). A reduction in apical rotation accounted for most of this alteration (4.5 ± 2.7° for grade 0, 4.7 ± 3.3° for grade 1 R and 8.9 ± 3.1° for controls, p < 0.017). There was no difference in peak LV twist among the transplant groups. Early diastolic LV untwisting (at 5%, 10% and 15% of diastole) did not significantly differ between the three groups. Speckle tracking imaging allows to detect a reduced LV twist in the transplanted heart. A reduced apical rotation accounts for most this alteration. However, our data suggests that the assessment of LV twist does not allow to detect the early stage of rejection.
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