Abstract
Introduction: Whether myocardial activation sequences in heart transplant (HT) recipients differ from non-transplanted structurally normal hearts is unknown. We performed a case control study to determine baseline myocardial activation sequences in stable heart transplant recipients utilizing Doppler tissue imaging (DTI) techniques. We then compared them to non-HT patients with structurally normal hearts to assess for potential differences between the two groups. Methods: We retrospectively reviewed our echocardiographic database and identified 11 HT recipients (8 males, 59±7 yrs) with normal LV systolic function. All transplants were performed>6 months from the time of the echocardiogram. We then analyzed DTI in these patients and compared them to 11 age matched controls (7 males, 64±10 yrs) with no evidence of structural heart disease. Patients with LV ejection fractions (LVEF)<55%, atrial fibrillation, permanent pacemakers, QRS duration>120 msec, or moderate or greater valvular heart disease were excluded. We analyzed DTI time intervals and peak velocities (GE Vivid 7). In DTI, onset of (ECG) Q wave to peak (DTI) S and E waves (Q-S, Q-E) was measured. An 8 segment global LV score was created by averaging 8 data points from the basal and mid-positions of the respective LV wall. Results: Baseline characteristics including age, sex, heart rate, LVEF, LV mass index, QRS duration and peak DTI velocities were not significantly different between the two groups. Conclusions: 1) DTI techniques allow detailed investigation into myocardial mechanics in HT recipients. 2) Stable HT recipients display altered patterns of ventricular activation sequences when compared to age matched non-HT recipients with normal LV systolic function. 3) Stable HT recipients demonstrated earlier activation and relaxation within the cardiac cycle as assessed by DTI. We speculate that the role of DTI in HT patients may expand, with potential applications including detection of rejection and allograft vasculopathy.ResultsHT (n=11)Control (n=11)p valueMean 4 chamber DTI Q-S (msec)145±26179±300.01Mean 2 chamber DTI Q-S (msec)126±14167±350.007Mean 4 chamber DTI Q-E (msec)448±26548±490.0002Mean 2 chamber DTI Q-E (msec)446±28550±490.00018 segment DTI Q-S(msec)136±18173±300.0068 segment DTI Q-E (msec)447±24549±560.0001
Published Version
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