title: Evaluation of longitudinal myocardial deformation by 2-dimensional speckle-tracking echocardiography in heart transplant recipients: relation to coronary allograft vasculopathy.
abstract: BACKGROUND
  Coronary allograft vasculopathy (CAV) in heart transplant (HTx) recipients is characterized by diffuse affection of epicardial and intramyocardial coronary vessels. Despite significant CAV and anticipated affected myocardial function, left ventricular ejection fraction (LVEF) is often within the normal range, indicating the need of more sophisticated non-invasive methods to detect impaired myocardial function caused by CAV. Global longitudinal strain (GLS) represents a new echocardiographic measurement of systolic myocardial deformation. The aim of the study was to evaluate the relation between GLS measured by 2-dimensional speckle-tracking echocardiography and CAV in HTx patients.
  
  
  METHODS
  The study included 178 HTx patients and 20 healthy, age-matched individuals. All patients had an extensive echocardiographic evaluation and coronary angiography assessing CAV. CAV was classified according to International Society of Heart and Lung Transplantation classification (CAV0-3).
  
  
  RESULTS
  CAV was seen in 38.8% of patients. Compared with controls (-20.6% ± 1.4%), GLS was significantly reduced according to the degree of CAV (CAV0, -16.7% ± 2.4%; CAV1, -15.2% ± 2.9%; CAV2-3, -14.0% ± 3.8%; controls, -20.6% ±1.4%; pTREND < 0.0001). In addition, we found decreasing peak systolic mitral annular velocities (pTREND = 0.0040), tissue-tracking values (pTREND = 0.0002), and LVEF according to CAV class (CAV0, 65.3% ± 5.4%; CAV2-3, 56.9% ± 11.7%; pTREND < 0.0001). The HTx population showed significant restrictive physiology compared with the control population, but no significant correlation was seen between CAV class and traditional diastolic parameters such as E/A ratio (pTREND = 0.38) or E-deceleration time (pTREND = 0.14).
  
  
  CONCLUSIONS
  In contrast to LVEF and conventional pulsed mitral Doppler flow parameters used in the CAV classification, GLS relates to the presence and degree of CAV. The present results suggest GLS as a new method to be included in the monitoring of graft function in relation to CAV.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. Electronic address: torclemm@rm.dk.
authors.forename: Tor Skibsted
authors.initials: TS
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Brian Bridal
authors.initials: BB
authors.lastname: Løgstrup
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Eiskjær
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Steen Hvitfeldt
authors.initials: SH
authors.lastname: Poulsen
mesh_terms: D064591:Allografts; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003718:Denmark / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D066027:Transplant Recipients; D016277:Ventricular Function, Left / Q000502:physiology
keywords: coronary allograft vasculopathy; global longitudinal systolic function; heart transplantation; speckle tracking