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Cardiac mechanics in heart transplant recipients with and without transplant vasculopathy

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Abstract

Evaluation of cardiac mechanics in heart transplant recipients (HTR) is of paramount importance. Assessment of strain through echocardiography is suited to describe cardiac function and might allow characterizing patients with and without transplant vasculopathy (TVP) a risk factor of impaired organ function and rejection. For this study 41 HTR immediately after and 1–3 years after transplantation were examined in a retrospective approach with 2-dimensional speckle tracking echocardiography to assess longitudinal, radial and circumferential strain and strain rate. The cohort consists of 33 men and 8 women with a median age of 54 years (1st, 3rd; 45.7, 65.3) with seven cases diagnosed with TVP during follow-up, as diagnosed by coronary angiography. The overall cohort showed an improvement of global longitudinal strain from baseline to 1 and 3 years with −14.2 % (−16.9, −12.3 %) to −16.1 % (−17.5, −14.3 %) and −16.7 % (−18, −13.7 %), p = 0.036. For patients developing TVP, global longitudinal strain was not different from baseline up to the maximum of 3 years −16.6 % (−16.7–13.8 %) to −16.4 % (−17.3, −14.7 %) and −17.6 % (−18.7, −16.9 %) with p = 0.21. Radial strain and torsion showed a trend to decrease after transplantation with time. Circumferential strain remained stable in HTR but decreased in subjects with TVP. Longitudinal Strain and strain rate showed no relevant changes in HTR with and without TVP. Radial strain and torsion declined in HTR as well as TVP patients with time. Speckle tracking imaging is useful to assess organ function in HTR, however coronary angiography is still needed to rule out TVP.

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Abbreviations

2D-ST:

2-Dimensional speckle tracking

CNI:

Calcineurin inhibitors

CS:

Circumferential strain

CSR:

Circumferential strain rate

EF:

Ejection fraction

EVE:

Everolimus

FS:

Fractional shortening

HTR:

Heart transplant recipient

LS:

Longitudinal strain

LSR:

Longitudinal strain rate

MMF:

Mycophenolat mofetil

MRI:

Magnectic resonance imaging

NT-proBNP:

N-terminal pro B-type natriuretic peptide

RS:

Radial strain

RSR:

Radial strain rate

TVP:

Transplant vasculopathy

References

  1. Stehlik J, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI, Dobbels F, Kirk R, Rahmel AO, Hertz MI (2012) The registry of the international society for heart and lung transplantation: 29th official adult heart transplant report—2012. J Heart Lung Transpl 31(10):1052–1064. doi:10.1016/j.healun.2012.08.002

    Article  Google Scholar 

  2. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, Fedson S, Fisher P, Gonzales-Stawinski G, Martinelli L, McGiffin D, Smith J, Taylor D, Meiser B, Webber S, Baran D, Carboni M, Dengler T, Feldman D, Frigerio M, Kfoury A, Kim D, Kobashigawa J, Shullo M, Stehlik J, Teuteberg J, Uber P, Zuckermann A, Hunt S, Burch M, Bhat G, Canter C, Chinnock R, Crespo-Leiro M, Delgado R, Dobbels F, Grady K, Kao W, Lamour J, Parry G, Patel J, Pini D, Towbin J, Wolfel G, Delgado D, Eisen H, Goldberg L, Hosenpud J, Johnson M, Keogh A, Lewis C, O’Connell J, Rogers J, Ross H, Russell S, Vanhaecke J (2010) The international society of heart and lung transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transpl 29(8):914–956. doi:10.1016/j.healun.2010.05.034

    Article  Google Scholar 

  3. Thorn EM, de Filippi CR (2007) Echocardiography in the cardiac transplant recipient. Heart Fail Clin 3(1):51–67. doi:10.1016/j.hfc.2007.02.008

    Article  PubMed  Google Scholar 

  4. Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, Mancini D, Patel J, Razi R, Reichenspurner H, Russell S, Segovia J, Smedira N, Stehlik J, Wagner F (2014) Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transpl 33(4):327–340. doi:10.1016/j.healun.2014.02.027

    Article  Google Scholar 

  5. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I et al (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American society of echocardiography committee on standards, subcommittee on quantitation of two-dimensional echocardiograms. J Am Soc Echocardiogr 2(5):358–367

    Article  CAS  PubMed  Google Scholar 

  6. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12(3):167–205. doi:10.1093/ejechocard/jer021

    Article  PubMed  Google Scholar 

  7. Eroglu E, Herbots L, Van Cleemput J, Droogne W, Claus P, D’Hooge J, Bijnens B, Vanhaecke J, Sutherland GR (2005) Ultrasonic strain/strain rate imaging–a new clinical tool to evaluate the transplanted heart. Eur J Echocardiogr 6(3):186–195. doi:10.1016/j.euje.2004.09.002

    Article  PubMed  Google Scholar 

  8. Marciniak A, Eroglu E, Marciniak M, Sirbu C, Herbots L, Droogne W, Claus P, D’Hooge J, Bijnens B, Vanhaecke J, Sutherland GR (2007) The potential clinical role of ultrasonic strain and strain rate imaging in diagnosing acute rejection after heart transplantation. Eur J Echocardiogr 8(3):213–221. doi:10.1016/j.euje.2006.03.014

    Article  PubMed  Google Scholar 

  9. Eleid MF, Caracciolo G, Cho EJ, Scott RL, Steidley DE, Wilansky S, Arabia FA, Khandheria BK, Sengupta PP (2010) Natural history of left ventricular mechanics in transplanted hearts: relationships with clinical variables and genetic expression profiles of allograft rejection. JACC Cardiovasc Imaging 3(10):989–1000. doi:10.1016/j.jcmg.2010.07.009

    Article  PubMed  Google Scholar 

  10. Pichler P, Binder T, Hofer P, Bergler-Klein J, Goliasch G, Lajic N, Aliabadi A, Zuckermann A, Syeda B (2012) Two-dimensional speckle tracking echocardiography in heart transplant patients: three-year follow-up of deformation parameters and ejection fraction derived from transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 13(2):181–186. doi:10.1093/ejechocard/jer239

    Article  PubMed  Google Scholar 

  11. Saleh HK, Villarraga HR, Kane GC, Pereira NL, Raichlin E, Yu Y, Koshino Y, Kushwaha SS, Miller FA Jr, Oh JK, Pellikka PA (2011) Normal left ventricular mechanical function and synchrony values by speckle-tracking echocardiography in the transplanted heart with normal ejection fraction. J Heart Lung Transpl 30(6):652–658. doi:10.1016/j.healun.2010.12.004

    Article  Google Scholar 

  12. Syeda B, Hofer P, Pichler P, Vertesich M, Bergler-Klein J, Roedler S, Mahr S, Goliasch G, Zuckermann A, Binder T (2011) Two-dimensional speckle-tracking strain echocardiography in long-term heart transplant patients: a study comparing deformation parameters and ejection fraction derived from echocardiography and multislice computed tomography. Eur J Echocardiogr 12(7):490–496. doi:10.1093/ejechocard/jer064

    Article  PubMed  Google Scholar 

  13. Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, Mestroni L, Page RL 2nd, Kobashigawa J (2004) Drug therapy in the heart transplant recipient: part I: cardiac rejection and immunosuppressive drugs. Circulation 110(24):3734–3740. doi:10.1161/01.CIR.0000149745.83186.89

    Article  PubMed  Google Scholar 

  14. Mehra MR, Crespo-Leiro MG, Dipchand A, Ensminger SM, Hiemann NE, Kobashigawa JA, Madsen J, Parameshwar J, Starling RC, Uber PA (2010) International society for heart and lung transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transpl 29(7):717–727. doi:10.1016/j.healun.2010.05.017

    Article  Google Scholar 

  15. Chatfield M, Mander A (2009) The Skillings–Mack test (Friedman test when there are missing data). Stata J 9(2):299–305

    PubMed Central  PubMed  Google Scholar 

  16. Cnaan A, Laird NM, Slasor P (1997) Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med 16(20):2349–2380. doi:10.1002/(SICI)1097-0258(19971030)16:20<2349:AID-SIM667>3.0.CO;2-E

    Article  CAS  PubMed  Google Scholar 

  17. Xanthakis V, Sullivan LM, Vasan RS (2013) Multilevel modeling versus cross-sectional analysis for assessing the longitudinal tracking of cardiovascular risk factors over time. Stat Med 32(28):5028–5038. doi:10.1002/sim.5880

    Article  PubMed Central  PubMed  Google Scholar 

  18. Dalen H, Thorstensen A, Aase SA, Ingul CB, Torp H, Vatten LJ, Stoylen A (2010) Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr 11(2):176–183. doi:10.1093/ejechocard/jep194

    Article  PubMed  Google Scholar 

  19. Dalen H, Thorstensen A, Vatten LJ, Aase SA, Stoylen A (2010) Reference values and distribution of conventional echocardiographic Doppler measures and longitudinal tissue Doppler velocities in a population free from cardiovascular disease. Circ Cardiovasc Imaging 3(5):614–622. doi:10.1161/CIRCIMAGING.109.926022

    Article  PubMed  Google Scholar 

  20. Sengupta PP, Khandheria BK, Korinek J, Wang J, Jahangir A, Seward JB, Belohlavek M (2006) Apex-to-base dispersion in regional timing of left ventricular shortening and lengthening. J Am Coll Cardiol 47(1):163–172. doi:10.1016/j.jacc.2005.08.073

    Article  PubMed  Google Scholar 

  21. Sengupta PP, Korinek J, Belohlavek M, Narula J, Vannan MA, Jahangir A, Khandheria BK (2006) Left ventricular structure and function: basic science for cardiac imaging. J Am Coll Cardiol 48(10):1988–2001. doi:10.1016/j.jacc.2006.08.030

    Article  PubMed  Google Scholar 

  22. Cheng A, Nguyen TC, Malinowski M, Daughters GT, Miller DC, Ingels NB Jr (2008) Heterogeneity of left ventricular wall thickening mechanisms. Circulation 118(7):713–721. doi:10.1161/CIRCULATIONAHA.107.744623

    Article  PubMed Central  PubMed  Google Scholar 

  23. Coppola BA, Omens JH (2008) Role of tissue structure on ventricular wall mechanics. Mol Cell Biomech 5(3):183–196

    PubMed Central  PubMed  Google Scholar 

  24. Pieper GM, Shah A, Harmann L, Cooley BC, Ionova IA, Migrino RQ (2010) Speckle-tracking 2-dimensional strain echocardiography: a new noninvasive imaging tool to evaluate acute rejection in cardiac transplantation. J Heart Lung Transpl 29(9):1039–1046. doi:10.1016/j.healun.2010.04.009

    Article  Google Scholar 

  25. Shi J, Pan C, Shu X, Sun M, Yang Z, Zhu S, Wang C (2011) The role of speckle tracking imaging in the noninvasive detection of acute rejection after heterotopic cardiac transplantation in rats. Acta Cardiol 66(6):779–785

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Elvin Zengin, Dirk Westermann, Ulf Radunski, Francisco Ojeda, Kai Muellerleile, Stefan Blankenberg & Christoph Sinning

  2. Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany

    Hermann Reichenspurner

Authors
  1. Elvin Zengin
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  2. Dirk Westermann
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  3. Ulf Radunski
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  4. Francisco Ojeda
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  8. Christoph Sinning
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Correspondence to Christoph Sinning.

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Zengin, E., Westermann, D., Radunski, U. et al. Cardiac mechanics in heart transplant recipients with and without transplant vasculopathy. Int J Cardiovasc Imaging 31, 795–803 (2015). https://doi.org/10.1007/s10554-015-0625-y

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  • DOI: https://doi.org/10.1007/s10554-015-0625-y

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