The potential clinical role of ultrasonic strain and strain rate imaging in diagnosing acute rejection after heart transplantation.
BACKGROUND
There has been a continued search for a more sensitive noninvasive technique for detecting sub-clinical acute rejection in heart transplant recipients. Ultrasonic deformation imaging (strain/strain rate) is sensitive in detecting sub-clinical abnormalities in regional systolic function and could potentially be sufficiently sensitive to detect changes in deformation induced by graft rejection.


OBJECTIVE
To assess the use of strain (S) and strain rate (SR) imaging as a noninvasive method for monitoring and diagnosing acute rejection in heart transplant recipients.


RESULTS
A prospective preliminary study was carried out involving 31 consecutive heart transplant patients who underwent a total of 106 routine follow up endomyocardial biopsy with correlative cardiac ultrasound data. To assess regional longitudinal deformation, ultrasonic S and SR data were acquired from the intraventricular septum, left ventricular (LV) lateral and right ventricular free walls (RVFW). For radial deformation, data were obtained from the LV posterior wall (LVPW). According to the International Society of Heart and Lung Transplantation criteria, 88 biopsies (Group 1) had grade 0 or IA rejection, and 18 biopsies (Group 2) had > or =grade IB rejection. Longitudinal peak systolic S and SR were decreased (p<0.05) in Group 2, compared to Group 1 in the RVFW basal and apical segments and the basal and mid segments of the LV lateral wall. Radial peak systolic S and SR were significantly lower (p<0.001) in Group 2, compared to Group 1.


CONCLUSIONS
S/SR imaging might be a good technique and an additional tool for detecting > or =IB grade of acute rejection. The myocardial deformation, as assessed by S/SR imaging could be of clinical value in monitoring and diagnosing acute rejection in heart transplant recipients and could improve patients' management by reducing the number of biopsies performed.
Marciniak
Anna
A
Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Eroglu
Elif
E
Marciniak
Maciej
M
Sirbu
Cristina
C
Herbots
Lieven
L
Droogne
Walter
W
Claus
Piet
P
D'hooge
Jan
J
Bijnens
Bart
B
Vanhaecke
Johan
J
Sutherland
George R
GR
D000208:Acute Disease; D000328:Adult; D004699:Endocardium / Q000000981:diagnostic imaging; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013599:Systole; D014180:Transplantation; D016896:Treatment Outcome; D014463:Ultrasonography