Three-Dimensional Speckle-Tracking Echocardiographic Monitoring of Acute Rejection in Heart Transplant Recipients.
OBJECTIVE
This study assessed the use of 3-dimensional (3D) speckle-tracking echocardiography for noninvasive monitoring and diagnosis of acute rejection in heart transplant recipients.


METHODS
Fifteen heart transplant recipients underwent 32 endomyocardial biopsies; echocardiography was performed within 3 hours before biopsy. Twenty-four biopsies (acute rejection-negative group) showed grade 0 or 1A rejection, and 8 biopsies (acute rejection-positive group) showed grade 1B or higher rejection (based on the International Society for Heart and Lung Transplantation criteria). Two-dimensional, M-mode, pulsed Doppler, and tissue Doppler echocardiography were performed to assess conventional heart structure and function, and 3D full-volume echocardiography was recorded and analyzed.


RESULTS
Global peak longitudinal strain was significantly lower in the acute rejection-negative group compared to the positive group (mean ± SD, -7.38% ± 1.34% versus -10.88% ± 3.81%; P = .017). Differences in left ventricular global peak radial strain (28.79% ± 10.79% versus 24.32% ± 5.24%; P= .272), global peak circumferential strain (-12.16% ± 4.87% versus -12.61% ± 2.38%; P = .806), and ejection fraction (49.42% ± 12.17% versus 50.68% ± 7.26%; P = .824) between the negative and positive groups were not significant. Significant correlations were observed between the left ventricular ejection fraction and global peak longitudinal, global peak radial, and global peak circumferential (r = -0.72; P < .001; r = 0.60; P < 0.001; and r = -0.69; P < 0.001, respectively). Receiver operating characteristic curve analysis showed that a global peak longitudinal strain cutoff value of less than -9.55% could predict grade 1B or higher rejection with sensitivity of 87.50% and specificity of 54.17%.


CONCLUSIONS
Three-dimensional speckle-tracking echocardiography-derived global peak longitudinal strain is a useful parameter for detecting acute rejection; thus, 3D speckle-tracking echocardiography can monitor dynamic and acute rejection (≥1B) in heart transplant recipients.
Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaKey Laboratories of Myocardial Ischemia Mechanism and Treatment, Harbin Medical University, Ministry of Education, Harbin, China.
Guo-Qing
GQ
Du
Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
Ming-Chon
MC
Hsiung
Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaKey Laboratories of Myocardial Ischemia Mechanism and Treatment, Harbin Medical University, Ministry of Education, Harbin, China.
Yan
Y
Wu
Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaKey Laboratories of Myocardial Ischemia Mechanism and Treatment, Harbin Medical University, Ministry of Education, Harbin, China.
Shao-Hui
SH
Qu
Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
Jeng
J
Wei
Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, TaiwanFaculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Wei-Hsian
WH
Yin
Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaKey Laboratories of Myocardial Ischemia Mechanism and Treatment, Harbin Medical University, Ministry of Education, Harbin, China jiaweitian@126.com.
Jia-Wei
JW
Tian
D000208:Acute Disease; D001706:Biopsy; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000473:pathology; D006321:Heart / Q000000981:diagnostic imaging; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results
3-dimensional speckle-tracking echocardiography; acute rejection; echocardiography; heart transplant