title: Utility of left ventricular systolic torsion derived from 2-dimensional speckle-tracking echocardiography in monitoring acute cellular rejection in heart transplant recipients.
abstract: BACKGROUND
  Reduced left ventricular torsion (LV-tor) has been reported to be associated with acute rejection in heart transplant (HTx) recipients. We investigated the utility of LV-tor analysis derived from 2-dimensional speckle-tracking echocardiography (2D-STE) for detecting allograft rejection.
  
  
  METHODS
  A total of 301 endomyocardial biopsies (EMBs), right heart catheterizations and echocardiograms were performed in 32 HTx recipients. Echocardiography was done within 3 hours from EMB or simultaneously with the procedures. The LV-tor was defined as the difference between apical and basal end-systolic rotations. The LV-tor values with and without cellular rejection were compared. In addition, we investigated whether the change in LV-tor values predicts the change in rejection grade in each patient. The baseline LV-tor value in each patient was defined as a mean value of the first 3 LV-tor measurements obtained when the patient was free from rejection.
  
  
  RESULTS
  According to the conventional International Society for Heart and Lung Transplantation criteria, 274 biopsies showed a rejection Grade of 0, 1a or 1b (Group AR(-)), whereas 27 biopsies were Grade 2 or higher (Group AR(+)). LV-tor decreased more in Group AR(+) than in Group AR(-) (9.3 ± 0.7 vs 12.2 ± 0.2 degrees, p < 0.0001). In the LV-tor measurement for each patient, the 25% reduction in LV-tor value from baseline predicted Grade 2 or higher rejection with a predictive accuracy of 92.9%.
  
  
  CONCLUSIONS
  LV-tor derived from 2D-STE could be of clinical value for non-invasive monitoring of acute rejection in HTx recipients.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sato
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Komamura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kamamura
authors.forename: Shuji
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shishido
authors.forename: Akiko
authors.initials: A
authors.lastname: Mano
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.forename: Ayako
authors.initials: A
authors.lastname: Takahashi
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.forename: Masanori
authors.initials: M
authors.lastname: Asakura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hashimura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014102:Torsion Abnormality / Q000000981:diagnostic imaging*; D014184:Transplantation, Homologous; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*