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Serial changes in longitudinal graft function and implications of acute cellular graft rejections during the first
Tor Skibsted Clemmensen1, Brian Bridal Løgstrup2, Hans Eiskjær2
1Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark torclemm@rm.dk.
Insights
Left ventricular global longitudinal strain (LV-GLS) can monitor heart transplant graft function. Acute cellular rejection (ACR) episodes impair LV-GLS recovery in the first year post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Echocardiography
Background:
- Heart transplantation (HTX) requires monitoring of graft function.
- Acute cellular rejection (ACR) is a significant complication affecting graft survival.
- Non-invasive methods for early detection of rejection are crucial.
Purpose of the Study:
- To evaluate left ventricular global longitudinal strain (LV-GLS) as a non-invasive marker for graft function.
- To assess the relationship between LV-GLS and acute cellular rejection (ACR) in the first year post-heart transplantation (HTX).
Main Methods:
- Prospective study of 36 heart transplant recipients.
- Echocardiography and endomyocardial biopsies performed at multiple time points up to 12 months post-HTX.
- Patients categorized based on ACR grade (≥2R) and compared for LV-GLS and tricuspid annular plane systolic excursion (TAPSE) changes.
Main Results:
- LV-GLS and TAPSE were significantly associated with ACR burden.
- Patients with ACR showed impaired LV-GLS improvement (-2.4% difference at 12 months) compared to ACR-free patients (-16.8% vs -14.4%).
- ACR group LV-GLS did not improve from 1 to 12 months, unlike the ACR-free group.
Conclusions:
- LV-GLS is a sensitive non-invasive indicator of graft function post-heart transplantation.
- ACR episodes significantly impede the recovery of left ventricular longitudinal function within the first year.
- Monitoring LV-GLS may aid in the early detection of subclinical rejection and guide management.
Aims:
The aim of this prospective study was to use left ventricular global longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of graft function in relation to acute cellular rejection (ACR) during the first year after heart transplantation (HTX).
Methods And Results:
The study population consisted of 36 patients undergoing HTX from November 2010 until October 2013. Patients were followed by comprehensive echocardiography and biopsies at 2 weeks and 1, 3, 6, and 12 months after HTX. ACRs were classified based on the ISHLT classification (0R-3R). Patients were divided into two groups according to the presence of one or more episodes of biopsy proven ≥grade 2R ACR during follow-up. We found that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were significantly related to ACR burden in a linear regression model. The absolute difference in LV-GLS between patients in the ACR group (-14.4%) and patients in the ACR-free group (-16.8%) was -2.4% (P < 0.01) 12 months after HTX. In the ACR group, patients' LV-GLS did not improve between 1 and 12 months, whereas an improvement of -2.9% was seen in the ACR-free group in this period (P < 0.01). The two groups appeared not to differ in terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE was 15.3 ± 2.8 mm in the ACR-free group vs. 13.2 ± 2.1 mm ACR group, P < 0.05, 12 months after HTX.
Conclusion:
Gradual improvement of longitudinal LV and RV function was seen within the first year after HTX, but the degree of recovery was strongly influenced by ACR episodes.
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