title: Feasibility and interpretation of global longitudinal strain imaging in pediatric heart transplant recipients.
abstract: Evaluation of myocardial mechanics after heart transplant is important in monitoring allograft function and identifying rejection. Speckle tracking global longitudinal strain (GLS) may be more sensitive to early regional changes from rejection. This study aimed to determine feasibility of GLS in pediatric hearts during surveillance echocardiograms, compare their GLS to published norms (-18% to -22%), and assess association of GLS with other indices of graft function. Retrospective review of transplant echocardiograms from 2013 to 2014. Philips QLAB was used for post-acquisition GLS analysis. Multiple linear regression was used to assess the association of GLS with echocardiographic/catheterization indices, and B-type natriuretic peptide (BNP). Forty-seven patients (84 studies) were included. Calculation of GLS was feasible in 82 studies (97%) with inter- and intra-observer variability of 0.71 and 0.69. Patients (n=9) with rejection had GLS of -16.4% (SD=3.5%) compared to those without [-16.8% (SD=3.7%)]. GLS worsened linearly with increasing Ln(BNP) (P=<.001), left ventricular volume in diastole (P=<.001), septal a' wave (P=<.001), and pulmonary capillary wedge pressure (P=<.001). Speckle tracking-based GLS is feasible and reproducible in pediatric heart recipients and is reduced at baseline. The role of GLS and BNP in detecting early systolic dysfunction warrants further investigation.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Wisotzkey
authors.affiliation: Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: Neal W
authors.initials: NW
authors.lastname: Jorgensen
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Albers
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Mariska S
authors.initials: MS
authors.lastname: Kemna
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Boucek
authors.affiliation: Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Yuk M
authors.initials: YM
authors.lastname: Law
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Aarti H
authors.initials: AH
authors.lastname: Bhat
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016027:Heart Transplantation; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015588:Observer Variation; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016277:Ventricular Function, Left
keywords: allograft function; brain natriuretic peptide; echocardiography; pediatric heart transplant; rejection; speckle tracking