Abstract
<h3>Purpose</h3> Speckle-tracking echocardiography analysis may identify minor, subtle myocardial dysfunction not detectable by standard echocardiography. This study aimed to explore longitudinal left ventricular (LV) and right ventricular (RV) function in relation to acute cellular rejections (ACRs) degree ≥ 2R and their response to intensify therapy with intravenous steroids. <h3>Methods</h3> 45 adult heart transplant recipients were prospectively assessed from January 2016 until May 2017. Among the biopsy specimens with ACR grade ≥ 2R, we identified those that underwent echocardiography before the episode of ACR, at the time of pathologic diagnosis, and during therapeutic intervention with 3 days of receiving intravenous steroids. <h3>Results</h3> 23 patients (51%) had at least 1 episode of moderate ACR during follow-up, and all these episodes were asymptomatic, with LVEF remaining in the normal range. Complete strain data in the ACR group were collected for 15 patients for all three time points. The cases of biopsy-proven ACR grade 2R were associated with marked reductions in GLS, 4-chamber longitudinal strain (4CH LS), systolic strain rate (SR), RV free wall longitudinal strain (RV FW) and increase of LV mechanical dyssynchrony (SD-TPS) (Tab. 1). There was an acute improvement of all LV and RV longitudinal strain parameters in reaction to appropriate immunosuppressive therapy for ACR in addition to no significant regression of LV mechanical dispersion (Tab. 2). <h3>Conclusion</h3> Measurements of LV and RV longitudinal strain are promising tools for the noninvasive assessment of ACR and to guide the pharmacological treatment of rejection.
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