Speckle tracking echocardiographyas a predictor of heart rejection in patients after orthotopic cardiac transplantation

Authors: T.V. Stavenchuk 1,2, 2, E.D. Kosmacheva 1,2, 2, I.A. Shelestova 1,2, 2, K.O. Barbukhatty 1,2, 2, V.A. Porkhanov 1,2, 2

Company: 1 S.V. Ochapovsky Region Clinical Hospital № 1; Ulitsa Pervogo Maya, 167, Krasnodar, 350063, Russian Federation;
2 Kubanskiy State Medical University of Ministry of Health of the Russian Federation; Ulitsa Sedina, 4, Krasnodar, 350063, Russian Federation.


DOI: https://doi.org/10.15275/kreatkard.2015.03.05

For citation:

Stavenchuk TV, Kosmacheva ED, Shelestova IA et al. Speckle tracking echocardiography as a predictor of heart rejection in patients after orthotopic cardiac transplantation. Creative Cardiology 2015; 3: 56-66 (in Russian)

Keywords: orthotopic cardiac transplantation deformation myocardium biopsy spacemen Global Peak Systolic Strain or strain rate of left ventricle

Download
Full text:  

 

Abstract

Objective. To accomplish comparative analysis of standard transthoracic echocardiography parameters and speckle tracking imaging, and estimate its’ predictive value on transplant rejection in patients after orthotopic cardiac transplantation.

Material and methods. From March, 2013 to May, 2014 64 recipients of heart transplant were surveyed after 3±0.3 years after transplantation in S.V. Ochapovsky Region Clinical Hospital № 1 of Krasnodar. The endomyocardial biopsy (EMB), transthoracic echocardiography (TTE), speckle tracking echocardiography were carried out in all patients. According to the results of EMB, following groups were defined: group 1 (n=40) – recipients without signs of cellular or humoral transplant rejection (AMR0 and ACR0); group 2 (n=15) – recipients with AMR 1 and/or ACR1; group 3 (n=4) – patients with AMR2 and/or ACR2; group 4 (n=5) – with chronic transplant rejection. The control group (n=40): patients without valvular pathology, arterial hypertension, coronary heart disease.

Results. The sensitivity of left ventricular ejection fraction (LV EF) in diagnostics of early rejection of heart transplant in group 2 makes up 30%, specificity – 90%, in group 3 – 60% and 97%, respectively; in group 4 – 57% and 97%. Speckle tracking echocardiography method revealed decrease of a global peak systolic strain of left ventricle (GLPS LV) in group 2 patients. Both parameters of GLPS LV and twisting were lowered in group 3. Meanwhile GLPS LV, radial peak systolic strain of LV (RadS LV), circumferential peak systolic strain of LV (CirS LV) and twist were lowered in group 4. The Sensitivity of GLPS LV in diagnostics of early rejection of heart transplant in group 2 was 73%, specificity – 93%, in group 3 – 90 and 95%, respectively.

Conclusion. GLPS LV can be considered as a diagnostic criterion at an early stage of transplant rejection (ACR1 and/or AMR1).

References

  1. Национальные клинические рекомендации. Трансплантация сердца. Общероссийская общественная организация трансплантологов «Российское трансплантологическое общество». М.: Триада; 2013: 92.

  2. Шумаков B.И. Трансплантация сердца. М.: Медицина; 2006.

  3. Шемякин С.Ю., Кормер А.Ю., Халилулин Т.А., Честухин В.В., Ильинский И.М. Особенности клинических проявлений острой реакции отторжения пересаженного сердца. Вестник трансплантологии и искусственных органов. 2010; 1: 7–16.

  4. Хадзегова А. Современные технологии в эхокардиографии. Медицинский вестник. 2010; 32: 537.

  5. Geyer Н., Caracciolo G., Abe H., Wilansky S., Carerj S. Assessment of Myocardial Mechanics Using Speckle Tracking Echocardiography: Fundamentals and Clinical Applications. J. Am. Society Echocardiogr. 2010; 23: 351–68.

  6. Sitia S., Tomasoni L., Turie M. Speckle tracking Echocardiography. A new technique for assessing myocardial function. J. Ultrasound Med. 2011; 30: 71–83.

  7. Алехин М.Н. Ультразвуковые методики оценки деформации миокарда и их клиническое значение. Допплеровская визуализация тканей в оценке деформации миокарда. Ультразвуковая и функциональная диагностика. 2011; 1: 104–17.

  8. Berry G.J., Burke M.M., Andersen C. et al. The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation J. Heart Lung Transplant. 2013; 32: 1148–61.

  9. Bader F.M., Islam N., Mehta N.A., Worthen N. Noninvasive Diagnosis of Cardiac Allograft Rejection Using Echocardiography Indices of Systolic and diastolic Function. J. Transplantation Proceedings. 2011; 43: 3877–81.

  10. Haydar K.S., Hector R. Villarraga Normal left ventricular mechanical function and synchrony values by speckle tracking echocardiography in the transplanted heart with normal ejection fraction. J. Heart Lung Transplant. 2011; l30: 652–8.

  11. Manankil M., Aggarwal A., Pauwaa A. Correlation of noninvasive markers of cardiac allograft rejection with endomyocardial biopsy. J. Heart Lung Transplant. 2012; l41: 518–21.

  12. Marciniaka А., Eroglua Е., Marciniaka М. The potentional role of ultrasonic strain imaging and immunophenotyping in diagnosing acute rejection after heart transplantation. EHJ Cardiovasc. Imaging. 2006; 8: 213–21.

  13. Sato T., Kato T.S. Utility of left ventricular systolic torsion derived from 2-dimensional speckle tracking echocardiography in monitoring acute cellular rejection in heart transplant recipients. J. Heart Lung Transplant. 2011; 5: 536–42.

  14. Kato T.S., Noboru O., Kazuhiko H. Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients. J. Cardiothorac. Surg. 2010; 37: 1104–10.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery