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Detection of cardiac allograft vasculopathy by multi-layer left ventricular longitudinal strain in heart transplant recipients

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Abstract

Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse type of coronaropathy that develops in the transplanted human heart, representing a major cause of graft failure and mortality. Nowadays the gold standard for the diagnosis of CAV is coronary angiography (CA). Non-invasive CAV detection, especially in the early stages of the disease, is still challenging. Our study aimed to investigate the role of speckle tracking echocardiography (STE), in particular three-layer STE, in predicting CAV at early stages, and if other traditional echocardiographic, clinical or biochemical parameters could relate to CAV. The study population was composed of a total of 33 heart transplanted patients, divided accordingly to the presence or absence of CAV (12 CAV+ , 22 CAV−). All subjects underwent a complete transthoracic echocardiographic examination on the same day of the CA, and all conventional parameters of myocardial function were obtained, including strain values assessed by STE. Strain values were significantly reduced in presence of CAV, at each myocardial layer but in particular the endocardial-epicardial gradient (− 4.15 ± 1.6 vs − 1.7 ± 0.4% < .0001) that was also highly predictive of CAV (AUC at ROC curve 0.97). Among diastolic parameters, the E wave deceleration time (DT) and the mean E/e′ ratio were strongly positively associated with CAV. In our population, left ventricular global longitudinal strain (GLS), layer-specific GLS and the endocardial-epicardial LS gradient, E wave DT and E/e′ ratio were the best independent non-invasive predictors of CAV.

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Author notes

  1. C. Sciaccaluga and G. E. Mandoli have contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy

    C. Sciaccaluga, G. E. Mandoli, N. Sisti, M. B. Natali, A. Ibrahim, D. Menci, S. Valente, S. Mondillo, M. Cameli & M. Focardi

  2. Department of Internal Medicine, University of Siena, Siena, Italy

    A. D’Errico & G. Donati

  3. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy

    G. Benfari

  4. Department of Cardiac Surgery, University Hospital of Siena, Siena, Italy

    S. Bernazzali & M. Maccherini

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Contributions

CS, GEM, NS, MBN, AI, DM, SV, SM, MC, MF: takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. AD’, GD: takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. GB: takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. SB, MM: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Correspondence to C. Sciaccaluga.

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Sciaccaluga, C., Mandoli, G.E., Sisti, N. et al. Detection of cardiac allograft vasculopathy by multi-layer left ventricular longitudinal strain in heart transplant recipients. Int J Cardiovasc Imaging 37, 1621–1628 (2021). https://doi.org/10.1007/s10554-020-02147-2

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