183 GLOBAL LONGITUDINAL STRAIN BY SPECKLE TRACKING ECHOCARDIOGRAPHY IN SUBCLINICAL ORTHOTOPIC HEART TRANSPLANT REJECTION

Abstract

Abstract Objective heart transplant (HT) patients need to be strictly monitored, especially within the first months after surgery by advanced and sensitive techniques, in order to rule out possible acute or subacute cellular rejection (CR) and hinder poor outcomes. This includes frequently repeated endomyocardial biopsy (EMB) and biomarkers. Echocardiography has emerged as an easily available and powered technique able to detect morphofunctional changes in various clinical settings. More recently, speckle tracking ultrasound and left ventricular (LV) strain have been documented as more accurate tools for detecting early myocardial dysfunction in most cardiac diseases. This study aimed at recognizing whether strain echocardiography can improve early diagnosis of subclinical CR. Methods We studied 32 patients, mean aged 52±4 years, who had undergone heart transplantation over the last 3 years at IRCCS ISMETT-UPMC (Palermo, Italy). They were scheduled for EMBs on a regular basis, and multisite biopsy specimens served to make diagnosis of CR. Conventional and advanced ultrasound measurements were performed on the same day of EMB. LV ejection fraction (LVEF) was assessed by using the Simpson rule biplane method and global longitudinal strain (GLS) by speckle tracking. Diastolic function was achieved by PW-Doppler/TDI sampling, as the E/E’ ratio. Echocardiographic findings were also related to anti-HLA antibodies (HAb). Results Multiple EMBs and ultrasound studies were performed in each patient. Echocardiographic findings from those likely to be healthy (CR- group) or with possible CR (CR+ group) are summarized in Table underneath (numbers are the average values of the various appraisals). Overall, 300 EMBs were negative (score 0-1) and 94 were positive (score 2-3). Global longitudinal strain and E/E’ ratio were significantly impaired in the first group, despite preserved LVEF. Tacrolimus therapeutic levels were similar between the groups, whereas a higher title of HAb was recognized in the CR+ group (13.3% vs 10.8%, p=0.012). Conclusions Cardiac ultrasound was confirmed to be a useful technique for monitoring HT patients over time. In those likely to have CR as by EMB specimens and HAb title, GLS and diastolic indices were significantly impaired irrespective of LVEF, suggesting speckle tracking echocardiography as a choice modality for detecting subclinical LV dysfunction in patients at risk of CR.