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Temporal changes in left ventricular strain with the development of rejection in paediatric heart transplant recipients

Published online by Cambridge University Press:  17 June 2019

Justin Godown Open the ORCID record for Justin Godown [Opens in a new window] ,
William A. McEachern ,
Debra A. Dodd ,
Michael Stanley ,
Corey Havens ,
Meng Xu ,
James C. Slaughter ,
David W. Bearl  and
Jonathan H. Soslow Open the ORCID record for Jonathan H. Soslow [Opens in a new window]
Justin Godown*
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
William A. McEachern
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Debra A. Dodd
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Michael Stanley
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Corey Havens
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Meng Xu
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
James C. Slaughter
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
David W. Bearl
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Jonathan H. Soslow
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
*
Author for correspondence: Justin Godown, MD, Vanderbilt University, Monroe Carell Jr. Children’s Hospital, Division of Pediatric Cardiology, 2200 Children’s Way, Suite 5230 DOT, Nashville, TN 37232-9119, USA. Tel: (615) 322-7447. Email: [email protected]
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Abstract

Introduction:

Myocardial strain measurements are increasingly used to detect complications following heart transplantation. However, the temporal association of these changes with allograft rejection is not well defined. The aim of this study was to describe the evolution of strain measurements prior to the diagnosis of rejection in paediatric heart transplant recipients.

Methods:

All paediatric heart transplant recipients (2004–2015) with at least one episode of acute rejection were identified. Longitudinal and circumferential strain measurements were assessed at the time of rejection and retrospectively on all echocardiograms until the most recent negative biopsy. Smoothing technique (LOESS) was used to visualise the changes of each variable over time and estimate the time preceding rejection at which alterations are first detectable.

Results:

A total of 58 rejection episodes were included from 37 unique patients. In the presence of rejection, there were decrements from baseline in global longitudinal strain (−18.2 versus −14.1), global circumferential strain (−24.1 versus −19.6), longitudinal strain rate (−1 versus −0.8), circumferential strain rate (−1.3 versus −1.1), peak longitudinal early diastolic strain rate (1.3 versus 1), and peak circumferential early diastolic strain rate (1.5 versus 1.3) (p<0.01 for all). The earliest detectable changes occurred 45 days prior to rejection with simultaneous alterations in myocardial strain and ejection fraction.

Conclusions:

Changes in graft function can be detected non-invasively prior to the diagnosis of rejection. However, changes in strain occur concurrently with a decline in ejection fraction. Strain measurements aid in the non-invasive detection of rejection, but may not facilitate earlier diagnosis compared to more traditional measures of ventricular function.

Keywords

Paediatricheart transplantstrainrejection
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 954 - 959
Copyright
© Cambridge University Press 2019 

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References

Dandel, M, Hetzer, R. Echocardiographic strain and strain rate imaging-clinical applications. Int J Cardiol 2009; 132: 11–24.CrossRefGoogle ScholarPubMed
Clemmensen, TS, Eiskjaer, H, Kofoed-Nielsen, PB, Hoyer, S, Poulsen, SH. Case of acute graft failure during suspected humoral rejection with preserved ejection fraction, but severely reduced longitudinal deformation detected by 2D-speckle tracking. Case Rep Transplant 2014; 2014: 173589.Google ScholarPubMed
Podrouzkova, H, Bedanova, H, Tretina, M, et al. Decrease in longitudinal strain in heart transplant recipients is associated with rejection. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159: 601–606.CrossRefGoogle ScholarPubMed
Mingo-Santos, S, Monivas-Palomero, V, Garcia-Lunar, I, et al. Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. J Am Soc Echocardiogr 2015; 28: 1149–1156.CrossRefGoogle ScholarPubMed
Lisi, M, Cameli, M, Tacchini, D, Ballo, P, Maccherini, M, Mondillo, S. Two-dimensional speckle tracking echocardiography of acute cardiac transplant rejection following pregnancy. J Clin Ultrasound 2012; 40: 451–454.CrossRefGoogle ScholarPubMed
Zoeller, BB, Miyamoto, SD, Younoszai, AK, Landeck, BF. 2nd. Longitudinal strain and strain rate abnormalities precede invasive diagnosis of transplant coronary artery vasculopathy in pediatric cardiac transplant patients. Pediatrc Cardiol 2016; 37: 656–662.CrossRefGoogle Scholar
Clemmensen, TS, Logstrup, BB, Eiskjaer, H, Poulsen, SH. Evaluation of longitudinal myocardial deformation by 2-dimensional speckle-tracking echocardiography in heart transplant recipients: Relation to coronary allograft vasculopathy. J Heart Lung Transplant 2015; 34: 195–203.CrossRefGoogle ScholarPubMed
Barbosa, JA, Mota, CC, Simoes, ESAC, Nunes Mdo, C, Barbosa, MM. Assessing pre-clinical ventricular dysfunction in obese children and adolescents: the value of speckle tracking imaging. Eur Heart J Cardiovasc Imaging 2013; 14: 882–889.CrossRefGoogle ScholarPubMed
Binnetoglu, FK, Yildirim, S, Topaloglu, N, et al. Early detection of myocardial deformation by 2D speckle tracking echocardiography in normotensive obese children and adolescents. Anatol J Cardiol. 2015; 15: 151–157.CrossRefGoogle ScholarPubMed
Kato, TS, Oda, N, Hashimura, K, et al. Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients. Eur J Cardio-thoracic Surg 2010; 37: 1104–1110.CrossRefGoogle ScholarPubMed
Marcus, KA, Barends, M, Morava-Kozicz, E, Feuth, T, de Korte, CL, Kapusta, L. Early detection of myocardial dysfunction in children with mitochondrial disease: an ultrasound and two-dimensional strain echocardiography study. Mitochondrion 2011; 11: 405–412.CrossRefGoogle ScholarPubMed
Stewart, S, Winters, GL, Fishbein, MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant 2005; 24: 1710–1720.CrossRefGoogle Scholar
Billingham, ME, Cary, NR, Hammond, ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. the international society for heart transplantation. J Heart Transplant 1990; 9: 587–593.Google Scholar
Berry, GJ, Angelini, A, Burke, MM, et al. The ISHLT working formulation for pathologic diagnosis of antibody-mediated rejection in heart transplantation: evolution and current status (2005–2011). Journal Heart Lung Transplant 2011; 30: 601–611.CrossRefGoogle Scholar
Laird, NM, Ware, JH. Random-effects models for longitudinal data. Biometrics 1982; 38: 963–974.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.CrossRefGoogle ScholarPubMed
Gursu, HA, Varan, B, Sade, E, Erdogan, I, Sezgin, A, Aslamaci, S. Evaluation of acute rejection by measuring strain and strain rate in children with heart transplant: a preliminary report. Exp Clin Transplant 2017; 15: 561–566.Google ScholarPubMed
Liu, HY, Deng, YB, Liu, K, et al. Left ventricular systolic strain of the cardiac allograft evaluated with three-dimensional speckle tracking echocardiography. J Huazhong Univ Sci Technol Med Sci 2013; 33: 765–769.CrossRefGoogle ScholarPubMed
Marciniak, A, Eroglu, E, Marciniak, M, et al. The potential clinical role of ultrasonic strain and strain rate imaging in diagnosing acute rejection after heart transplantation. Eur J Echocardiography 2007; 8: 213–221.CrossRefGoogle ScholarPubMed
Pieper, GM, Shah, A, Harmann, L, Cooley, BC, Ionova, IA, Migrino, RQ. Speckle-tracking 2-dimensional strain echocardiography: a new noninvasive imaging tool to evaluate acute rejection in cardiac transplantation. J Heart Lung Transplant 2010; 29: 1039–1046.CrossRefGoogle ScholarPubMed
Syeda, B, Hofer, P, Pichler, P, et al. Two-dimensional speckle-tracking strain echocardiography in long-term heart transplant patients: a study comparing deformation parameters and ejection fraction derived from echocardiography and multislice computed tomography. Eur J Echocardiography 2011; 12: 490–496.CrossRefGoogle ScholarPubMed
Dodd, DA, Brady, LD, Carden, KA, Frist, WH, Boucek, MM, Boucek, RJ Jr. Pattern of echocardiographic abnormalities with acute cardiac allograft rejection in adults: correlation with endomyocardial biopsy. J Heart Lung Transplant 1993; 12: 1009–1017.Google ScholarPubMed
Clemmensen, TS, Eiskjaer, H, Logstrup, BB, Ilkjaer, LB, Poulsen, SH. Left ventricular global longitudinal strain predicts major adverse cardiac events and all-cause mortality in heart transplant patients. J Heart Lung Transplant 2017; 36: 567–576.CrossRefGoogle ScholarPubMed
Godown, J, Dodd, DA, Stanley, M, et al. Changes in left ventricular strain parameters following pediatric heart transplantation. Pediatr Transplant 2018; 22: e13166.CrossRefGoogle ScholarPubMed
Kailin, JA, Miyamoto, SD, Younoszai, AK, Landeck, BF. Longitudinal myocardial deformation is selectively decreased after pediatric cardiac transplantation: a comparison of children 1 year after transplantation with normal subjects using velocity vector imaging. Pediatri Cardiol 2012; 33: 749–756.CrossRefGoogle ScholarPubMed
Saleh, HK, Villarraga, HR, Kane, GC, et al. 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; 30: 652–658.CrossRefGoogle ScholarPubMed
Gossett, JG, Canter, CE, Zheng, J, et al. Decline in rejection in the first year after pediatric cardiac transplantation: a multi-institutional study. J Heart Lung Transplant 2010; 29: 625–632.CrossRefGoogle ScholarPubMed
Kirklin, JK, Naftel, DC, Bourge, RC, et al. Rejection after cardiac transplantation. A time-related risk factor analysis. Circulation 1992; 86: II236–241.Google ScholarPubMed
Pichler, P, Binder, T, Hofer, P, et al. Two-dimensional speckle tracking echocardiography in heart transplant patients: three-year follow-up of deformation parameters and ejection fraction derived from transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13: 181–186.CrossRefGoogle ScholarPubMed
Wisotzkey, BL, Jorgensen, NW, Albers, EL, et al. Feasibility and interpretation of global longitudinal strain imaging in pediatric heart transplant recipients. Pediatr Transplant 2017; 21: e12909.CrossRefGoogle ScholarPubMed
Koopman, LP, Slorach, C, Hui, W, et al. Comparison between different speckle tracking and color tissue Doppler techniques to measure global and regional myocardial deformation in children. J Am Soc Echocardiography 2010; 23: 919–928.CrossRefGoogle ScholarPubMed
Koopman, LP, Slorach, C, Manlhiot, C, et al. Assessment of myocardial deformation in children using Digital Imaging and Communications in Medicine (DICOM) data and vendor independent speckle tracking software. J Am Soc Echocardiography 2011; 24: 37–44.CrossRefGoogle Scholar