Related Experiment Video
Updated: Dec 7, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Longitudinal Strain and Strain Rate for Estimating Left Ventricular Filling Pressure in Heart Transplant Recipients
Ayse Colak1, Haldun Muderrisoglu1, Bahar Pirat1
1Cardiology Department, University of Baskent, Ankara, Turkey.
Insights
Global longitudinal strain (GLS) and strain rate (SR) accurately estimate left ventricular filling pressure (LVFP) in heart transplant recipients. These echocardiographic parameters are superior to traditional measures for assessing LVFP, regardless of ejection fraction or allograft vasculopathy.
Area of Science:
- Cardiology
- Cardiac Imaging
- Transplant Medicine
Background:
- Traditional echocardiographic parameters have limited accuracy in estimating left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients.
- Elevated LVFP is a critical concern in OHT patients, impacting graft function and long-term outcomes.
- Novel strain imaging parameters may offer improved assessment of LVFP in this population.
Purpose of the Study:
- To evaluate the efficacy of global longitudinal strain (GLS) and diastolic/systolic strain rate (SR) in estimating LVFP in OHT recipients.
- To compare the diagnostic accuracy of GLS and SR with traditional echocardiographic indices for predicting elevated LVFP.
- To assess the reliability of these parameters across varying left ventricular ejection fraction (LVEF) and in the presence of allograft vasculopathy.
Main Methods:
- Consecutive OHT patients undergoing endomyocardial biopsy and pre-transplant studies were included.
- Comprehensive echocardiography with GLS and SR measurements was performed.
- Results were correlated with pulmonary capillary wedge pressure (PCWP) obtained via right heart catheterization.
Main Results:
- Global longitudinal strain (GLS), E/e'SR, and systolic SR demonstrated higher accuracy (AUC 0.932, 0.849, 0.848 respectively) than traditional parameters in predicting PCWP > 12 mm Hg.
- GLS, systolic SR, and E/e'SR remained accurate predictors of LVFP irrespective of LVEF and allograft vasculopathy.
- Changes in GLS and E/e'SR closely tracked changes in PCWP, indicating their utility in monitoring LVFP.
Conclusions:
- Traditional diastolic function indices perform poorly in OHT recipients for LVFP estimation.
- GLS and E/e'SR provide reliable and accurate assessment of LVFP in OHT patients, independent of LVEF and allograft vasculopathy.
- These advanced strain parameters are valuable tools for monitoring LVFP in heart transplant recipients.
Abstract:
Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic, and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pretransplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared with pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8 ± 4.3 mm Hg (range: 4 to 25 mm Hg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e'), were different between studies with normal (n = 47) and elevated PCWP (n = 27). Area Under Curve for GLS (0.932*), E/e'SR (0.849*), and systolic SR (0.848*) (*p <0.0001) were more accurate than traditional parameters for predicting PCWP>12 mm Hg. GLS, systolic SR and E/e'SR remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e' was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e'SR tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e'SR provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP.
