The use of echocardiography post heart transplantation

Close surveillance for acute rejection (AR) and cardiac allograft vasculopathy (CAV) is essential for graft and patient survival. Because CAV can arise and progress without symptoms and subclinical ARs can facilitate CAV development, standard surveillance of AR and CAV is based on routine endomyocardial biopsies (EMBs) and coronary angiographies (CA) performed at predefined time intervals. These invasive screening tests can be quite distressing for patients, yet they cannot identify all sub-clinical ARs or coronary stenoses prior to a clinical event. Additional close-meshed non-invasive surveillance strategies are therefore mandatory.

After the introduction of Doppler tissue-imaging (DTI) and strain-imaging for myocardial wall motion and deformation analysis, echocardiography became more promising for post-transplant patient surveillance because these techniques which allow quantification of minor myocardial dysfunction not detectable by standard echocardiography appeared particularly suited for early detection of subclinical AR and CAV. The article summarizes the knowledge and clinical experience on the usefulness of echocardiography including DTI and strain-imaging for AR and CAV surveillance. Expert commentary: DTI and strain-imaging can be an important complement to EMB enabling more efficient AR monitoring with fewer EMBs instead of unnecessary and distressing routine EMB-screenings. Myocardial velocity and deformation imaging is also suited for early detection of myocardial dysfunction induced by CAV, prognostic evaluation of CAV and timing of CAs aimed to reduce the number of routine CA-screenings. However, further studies are necessary before specific recommendations for the use of DTI and strain imaging for CAV surveillance are possible.