Serial changes in longitudinal graft function and implications of acute cellular graft rejections during the first year after heart transplantation

Abstract

Aims: 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).

Methods and 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.

Conclusion: 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.

Keywords: cardiac allograft vasculopathy; global longitudinal systolic function; heart transplantation; rejection; speckle tracking.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Figures

Figure 1

Margin plots with 95% confidence interval in reference to time after HTX in the ACR group and the ACR-free group. (A) Systolic blood pressure, (B) diastolic blood pressure, (C) heart rate, (D) tricuspid regurgitation gradient. *P > 0.05 comparing the ACR group and the ACR-free group.

Figure 2

Bulls eye 17-segment model of global longitudinal strain. (A–C) HTX Patient I: four 1R rejections and 0 ≥ 2R rejections during follow-up. (A) Baseline; (B) 1 month after HTX; and (C) 12 months after HTX. Normal epicardial vessels at coronary angiography 12 months after HTX. (D–F) HTX Patient II: eight 1R rejections and two 2R rejections (after 5 weeks and after 6 months) during follow-up. (D) Baseline; (E) 1 month after HTX; and (F) 12 months after HTX. Normal epicardial vessels at coronary angiography 12 months after HTX.

Figure 3

Margin plots with 95% confidence interval in reference to time after HTX in the ACR group and the ACR-free group. (A) Left ventricular global longitudinal strain, (B) tricuspid annular plane systolic excursion, (C) left ventricular ejection fraction, (D) left ventricular global circumferential strain. *P > 0.05 comparing the ACR group and the ACR-free group. **P < 0.05 comparing the ACR group and the ACR-free group.

Figure 4

Scatter plots with regression lines for (A) left ventricular global longitudinal strain 12 months after HTX; (B) tricuspid annular plane systolic excursion 12 months after HTX; (C) left ventricular ejection fraction 12 months after HTX; (D) left ventricular global circumferential strain 12 months after HTX in reference to total rejection score within first year after HTX.