Intensified Statin Preserves Global Longitudinal Strain in Transplanted Heart

Abstract

Left ventricular (LV) global longitudinal strain (GLS) is a robust marker of subclinical myocardial dysfunction. Previous studies showed that as small as 2% reduction in GLS predicted major adverse event in heart transplant (HT) recipients, including cardiac allograft vasculopathy (CAV). Although low intensity statin is commonly used after HT to reduce CAV, the incremental impact of statin intensity on myocardial function is unknown. A single center, retrospective review was conducted in all adult HT recipients between 2012 and 2016. Patients were excluded for: death, LV ejection fraction <50%, rejection ≥ ISHLT 2R, angiographic CAV and interrupted statin therapy. Echocardiograms performed at 1 and 3-year outpatient follow-up were reviewed for remaining patients, who were further excluded for having poor acoustic windows. Included patients were divided into those on low intensity statin (pravastatin 20-40mg) and clinically intensified statin (atorvastatin 10mg or higher intensity) at 1-year follow up and were compared for GLS. Measurements of GLS were performed on apical views by two readers blinded to statin exposure. Forty-three HT recipients (low intensity statin, n=21; intensified statin, n=22) comprised the study population. Age, sex, donor age, presence of pre-HT VAD, and immunosuppression regimen were not significantly different between groups. Importantly, GLS was preserved in HT recipients receiving intensified statin (-17.0 ± 3.3 vs. -17.1 ± 2.5%, p=0.62) but significantly reduced in low intensity statin group (-17.5 ± 2.5 vs. -15.8 ± 2.5%, p=0.029, Figure 1A). The degree of GLS reduction was significantly higher during low intensity statin use (1.8 ± 1.5%) in comparison to intensified statin (0.13 ± 2.7%, p=0.044, Figure 1B). Interobserver correlation coefficient was 0.95. Intensified statin after HT is associated with preservation of myocardial function during intermediate term follow up, indicating a favorable impact of intensifying statin regimen after HT.