title: Strain and strain rate imaging using speckle tracking in acute allograft rejection in children with heart transplantation.
abstract: Acute allograft rejection is a major cause of morbidity and mortality following heart transplantation. There is no reliable noninvasive test to diagnose rejection. We aimed to investigate the accuracy of strain by speckle tracking echocardiography in the detection of acute rejection. We identified acute rejection episodes in patients followed at a single transplant center. Data were collected at baseline, during rejection and two follow-up points. Peak systolic radial and circumferential strain at the level of papillary muscles and peak systolic longitudinal strain from apical four-chamber view were analyzed offline. ANOVA was used for comparison between groups. p value ≤0.05 was considered significant. Fifteen rejection episodes were identified. There were no differences in the fractional shortening, LV posterior wall thickness, E/A, septal E/E', septal S', lateral E/E', lateral S', or MPI during rejection, compared to baseline. There was a significant increase in the LV mass during a rejection episode (47.5 vs. 34.4 g/ht(2.7) [p = 0.03]). The peak systolic radial strain (18.3 vs. 26.5; p = 0.03), longitudinal strain (-11.7 vs. -14.6; p = 0.05), and circumferential strain (-14.4 vs. -21.7; p = 0.05) declined significantly during rejection. In conclusion, peak systolic radial, longitudinal and circumferential strain decline and LV mass increases during an episode of rejection.
authors.affiliation: Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
authors.forename: Swati
authors.initials: S
authors.lastname: Sehgal
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Blake
authors.forename: Julie
authors.initials: J
authors.lastname: Sommerfield
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D009202:Cardiomyopathies / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000503:physiopathology; D006333:Heart Failure / Q000151:congenital / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: allograft rejection; children; heart transplant; speckle tracking