title: 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.
abstract: OBJECTIVE
  Longitudinal strain determined by speckle tracking is a sensitive parameter to detect systolic left ventricular dysfunction. In this study, we assessed regional and global longitudinal strain values in long-term heart transplants and compared deformation indices with ejection fraction as determined by transthoracic echocardiography (TTE) and multislice computed tomographic coronary angiography (MSCTA).
  
  
  RESULTS
  TTE and MSCTA were prospectively performed in 31 transplant patients (10.6 years post-transplantation) and in 42 control subjects. Grey-scale apical views were recorded for speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. The presence of coronary artery disease (CAD) was assessed by MSCTA. Strain analysis was performed in 1168 segments [496 in transplant patients (42.5%), 672 in control subjects (57.7%)]. Global longitudinal peak systolic strain was significantly lower in the transplant recipients than in the healthy population (-13.9 ± 4.2 vs. -17.4 ± 5.8%, P< 0.01). This was still the case after exclusion of the nine transplant patients with CAD (-14.1 ± 4.4 vs. -17.4 ± 5.8%, P=0.03). Transplant patients exhibited significantly lower regional strain values in 9 of the 16 segments. Left ventricular ejection fraction (%) (MSCTA/Simpsons method) was 60.7 ± 10.1%/60.2 ± 6.7% in transplant recipients vs. 64.7 ± 6.4%/63.0 ± 6.2% in the healthy population, P=ns.
  
  
  CONCLUSIONS
  Even though 'healthy' heart transplants without CAD exhibit normal ejection fraction, deformation indices are reduced in this population when compared with control subjects. Our findings suggests that strain analysis is more sensitive than assessment of ejection fraction for the detection of abnormalities of systolic function.
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna, Austria. bonni.syeda@meduniwien.ac.at
authors.forename: Bonni
authors.initials: B
authors.lastname: Syeda
authors.forename: Peter
authors.initials: P
authors.lastname: Höfer
authors.forename: Philipp
authors.initials: P
authors.lastname: Pichler
authors.forename: Markus
authors.initials: M
authors.lastname: Vertesich
authors.forename: Jutta
authors.initials: J
authors.lastname: Bergler-Klein
authors.forename: Susanne
authors.initials: S
authors.lastname: Roedler
authors.forename: Stephane
authors.initials: S
authors.lastname: Mahr
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Thomas
authors.initials: T
authors.lastname: Binder
mesh_terms: D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000295:instrumentation; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D004452:Echocardiography / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006305:Health Status Indicators; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013223:Statistics as Topic; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D014056:Tomography, X-Ray / Q000295:instrumentation* / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology; D016277:Ventricular Function, Left