Speckle-Tracking Echocardiography for Monitoring Acute Rejection in Transplanted Heart.

Area of Science:

• Cardiology
• Transplant Medicine
• Medical Imaging

Background:

• Acute cellular rejection (ACR) is a critical concern in heart transplant recipients.
• Accurate diagnosis of ACR is essential for graft survival.
• Noninvasive methods for monitoring rejection are highly desirable.

Purpose of the Study:

• To evaluate the effectiveness of speckle-tracking echocardiography parameters in detecting acute cellular rejection in heart transplant patients.
• To develop a novel echocardiographic index for identifying patients at risk of graft rejection.

Main Methods:

• Prospective study of 45 heart transplant recipients undergoing 220 endomyocardial biopsies (EMBs).
• Echocardiographic examinations were performed correlating with EMB results.
• Analysis focused on longitudinal, radial, and circumferential strain parameters, particularly right ventricular (RV) free wall longitudinal strain (FW LS) and 4-chamber longitudinal strain (4CH LS).

Main Results:

• Longitudinal strain parameters (LV and RV) were significantly reduced in patients with ACR compared to the ACR-free group.
• RV FW LS ≤ 16.8% and 4CH LS ≤ 13.8% were associated with ACR requiring treatment.
• A novel Strain Rejection Score (SRS) combining these parameters demonstrated high specificity and negative predictive value for detecting ACR (≥2R).

Conclusions:

• The Strain Rejection Score (SRS), derived from 4CH LS and RV FW LS, offers a valuable noninvasive tool for assessing ACR risk.
• This echocardiographic index can aid in the early detection of graft rejection in the first year post-heart transplant.