title: Serial changes in longitudinal graft function and implications of acute cellular graft rejections during the first year after heart transplantation.
abstract: OBJECTIVE
  The aim of this prospective study was to use left ventricular global longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of graft function in relation to acute cellular rejection (ACR) during the first year after heart transplantation (HTX).
  
  
  RESULTS
  The study population consisted of 36 patients undergoing HTX from November 2010 until October 2013. Patients were followed by comprehensive echocardiography and biopsies at 2 weeks and 1, 3, 6, and 12 months after HTX. ACRs were classified based on the ISHLT classification (0R-3R). Patients were divided into two groups according to the presence of one or more episodes of biopsy proven ≥grade 2R ACR during follow-up. We found that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were significantly related to ACR burden in a linear regression model. The absolute difference in LV-GLS between patients in the ACR group (-14.4%) and patients in the ACR-free group (-16.8%) was -2.4% (P < 0.01) 12 months after HTX. In the ACR group, patients' LV-GLS did not improve between 1 and 12 months, whereas an improvement of -2.9% was seen in the ACR-free group in this period (P < 0.01). The two groups appeared not to differ in terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE was 15.3 ± 2.8 mm in the ACR-free group vs. 13.2 ± 2.1 mm ACR group, P < 0.05, 12 months after HTX.
  
  
  CONCLUSIONS
  Gradual improvement of longitudinal LV and RV function was seen within the first year after HTX, but the degree of recovery was strongly influenced by ACR episodes.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark torclemm@rm.dk.
authors.forename: Tor Skibsted
authors.initials: TS
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark.
authors.forename: Brian Bridal
authors.initials: BB
authors.lastname: Løgstrup
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Eiskjær
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark.
authors.forename: Steen Hvitfeldt
authors.initials: SH
authors.lastname: Poulsen
mesh_terms: D000328:Adult; D001706:Biopsy; D017023:Coronary Angiography; D003718:Denmark; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging* / Q000401:mortality
keywords: cardiac allograft vasculopathy; global longitudinal systolic function; heart transplantation; rejection; speckle tracking