title: Two-dimensional speckle tracking echocardiography in heart transplant patients: three-year follow-up of deformation parameters and ejection fraction derived from transthoracic echocardiography.
abstract: OBJECTIVE
  Non-invasive diagnosis of allograft dysfunction is a major objective in the management of heart transplant (HTX) recipients. Speckle tracking echocardiography (STE) permits comprehensive assessment of myocardial function. It is well established that deformation indices are reduced in HTXs when compared with control subjects. However, it is unclear if the reduction in strain is a chronic progressive phenomenon in HTX patients.  Method and results Follow-up transthoracic echocardiography (TTE) was performed 3 years after initial TTE in 20 'healthy' HTX patients (13.2 years post-transplantation at time of follow-up) with normal ejection fraction and angiographically ruled out allograft vasculopathy. Grey-scale apical views were recorded and stored for automated offline speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. Strain analysis was performed in 320 segments 34.3 ± 3.7 months after initial assessment. Automated tracking of myocardial deformation for determination of longitudinal systolic strain was not possible in 24 (7.5%) segments at baseline and in 32 (10.0%) segments at follow-up (P = ns). The left ventricular ejection fraction (LVEF) was 61.9 ± 8.1% at the initial examination vs. 62.8 ± 5.8% 3 years afterwards (P = ns). Global longitudinal peak systolic strain was -14.0 ± 4.0 vs. -14.4 ± 2.8%, respectively (P = ns).
  
  
  CONCLUSIONS
  This is the first study describing follow-up deformation parameters in HTX patients undergoing STE. 'Healthy' HTX patients with normal coronary arteries and normal ejection fractions showed no deterioration of longitudinal strain values 3 years after the initial assessment. Apparently, deformation values remain stable over the years as long as the LVEF is preserved.
authors.affiliation: Department of Cardiology,  Internal Medicine II, Medical University of Vienna, Waehringer, Gürtel 18-20 Vienna A-1090,  Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Pichler
authors.forename: Thomas
authors.initials: T
authors.lastname: Binder
authors.forename: Peter
authors.initials: P
authors.lastname: Höfer
authors.forename: Jutta
authors.initials: J
authors.lastname: Bergler-Klein
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.forename: Natalija
authors.initials: N
authors.lastname: Lajic
authors.forename: Arezu
authors.initials: A
authors.lastname: Aliabadi
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Bonni
authors.initials: B
authors.lastname: Syeda
mesh_terms: D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume; D014184:Transplantation, Homologous