title: Impact of asymptomatic acute cellular rejection on left ventricle myocardial function evaluated by means of two-dimensional speckle tracking echocardiography in heart transplant recipients.
abstract: BACKGROUND
  Our objective was to evaluate the impact of asymptomatic acute cellular rejection (ACR) in left ventricular myocardial strain in heart transplant (HT) recipients by means of two-dimensional speckle tracking echocardiography (2DSTE).
  
  
  METHODS
  From September 1, 2009 to December 15, 2010 a conventional echocardiography and 2DSTE exam was performed on all consecutive HT recipients in their first year posttransplantation within 3 hours of the surveillance endomyocardial biopsies, as well as on 14 healthy controls. The association of strain echocardiographic variables with different grades of ACR was investigated.
  
  
  RESULTS
  Of the 78 studies performed 4 ± 3 months after HT in 20 patients, 32 studies were coincident with grade 0R rejection, 41 with grade 1R, and 5 with grade 2R. Significantly lower values of average radial strain were found with higher grades of ACR (29.1 ± 7.7%, 23.2 ± 8.5%, and 14.3 ± 8.8% for grades 0R, 1R, and 2R of ACR, P = 0.001). Average deformation was similar for controls versus transplanted patients, in the absence of acute rejection: radial 29.1 ± 10.0% versus 29.1 ± 7.7%, P = 0.98; circumferential -19.3 ± 3.2% versus -20.2 ± 5.9%, P = 0.62; and longitudinal -20.7 ± 4.1% versus -18.5 ± 5.4%, P = 0.19. An average radial strain <25% presented 100% sensitivity, 48% specificity, 6% positive predictive value, and 100% negative predictive value for the presence of 2R rejection (area under the curve 0.80, IC 95% 0.60-0.99, P = 0.048).
  
  
  CONCLUSIONS
  In this study, HT recipients showed significantly lower values of average radial left ventricle strain, evaluated by means of 2DSTE, with the presence of ACR.
authors.affiliation: Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Martín
authors.initials: M
authors.lastname: Ruiz Ortiz
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Peña
authors.forename: Dolores
authors.initials: D
authors.lastname: Mesa
authors.forename: Mónica
authors.initials: M
authors.lastname: Delgado
authors.forename: Elías
authors.initials: E
authors.lastname: Romo
authors.forename: Marta
authors.initials: M
authors.lastname: Santisteban
authors.forename: Miguel
authors.initials: M
authors.lastname: Puentes
authors.forename: Amador
authors.initials: A
authors.lastname: López Granados
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Castillo
authors.forename: José María
authors.initials: JM
authors.lastname: Arizón
authors.forename: José Suárez
authors.initials: JS
authors.lastname: de Lezo
mesh_terms: D000208:Acute Disease; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D066027:Transplant Recipients; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: heart transplantation; rejection; speckle tracking echocardiography; strain