Journal of the American Society of Echocardiography
Clinical InvestigationHeart TransplantationEarly Postoperative Left Ventricular Function by Echocardiographic Strain is a Predictor of 1-Year Mortality in Heart Transplant Recipients
Section snippets
Methods
In total, 176 consecutive adult primary orthotopic heart transplant recipients at the national HTx center (Oslo University Hospital, Rikshospitalet, Oslo, Norway) between August 2001 and August 2007 were retrospectively evaluated for eligibility in this study. Of these patients, 167 had analyzable echocardiographic studies, performed 13 ± 6 days after HTx (Table 1).
Peak systolic longitudinal myocardial strain by 2D STE was assessed in 16 LV segments and averaged to calculate LVGLS, an index of
Results
We retrospectively evaluated 176 consecutive adult primary orthotopic heart transplant recipients. Assessment of LVGLS was not feasible because of poor image quality in one nonsurvivor (6%) and eight survivors (5%). Of 2,672 myocardial segments, 2,173 (81%) were analyzed.
During the first year, 15 patients (9%) died 86 ± 72 days after HTx. All heart transplant recipients received inotropes the first 3 to 5 days after transplantation. Five nonsurvivors (33%) and 32 survivors (21%) were
Discussion
Assessment of LV function by echocardiographic global longitudinal strain was a sensitive marker of poor clinical outcome in the present study. Reduced deformation assessed by strain was the only noninvasive independent predictor of 1-year mortality in heart transplant recipients, together with the well-established invasive prognostic variable PVR.15
LV dysfunction is known to be a robust prognostic marker of adverse outcomes19 and has been most commonly assessed using LVEF by the Simpson
Conclusions
Reduced cardiac function by LVGLS early after HTx is related to increased 1-year mortality. Early assessment of strain provides important prognostic information that may have clinical and therapeutic implications in heart transplant recipients. Speckle-tracking strain echocardiography has the potential to be a useful noninvasive screening tool, in addition to invasive right-heart catheterization and endomyocardial biopsy, to identify heart transplant recipients with a high risk for poor
References (33)
- et al.
The prognostic importance of modifiable risk factors after heart transplantation
Am Heart J
(2009) - et al.
The Registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult heart transplant report—2011
J Heart Lung Transplant
(2011) - et al.
New-onset graft dysfunction after heart transplantation—incidence and mechanism-related outcomes
J Heart Lung Transplant
(2011) - et al.
Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin's lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy
Am J Cardiol
(2011) - et al.
Stability of right and left ventricular ejection fractions and volumes after heart transplantation
J Heart Lung Transplant
(2005) - et al.
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
J Am Soc Echocardiogr
(2011) - et al.
Acute regional myocardial ischemia identified by 2-dimensional multiregion tissue Doppler imaging technique
J Am Soc Echocardiogr
(2000) - et al.
Mean strain throughout the heart cycle by longitudinal two-dimensional speckle-tracking echocardiography enables early prediction of infarct size
J Am Soc Echocardiogr
(2011) - et al.
Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection
J Heart Lung Transplant
(2005) - et al.
The ISHLT working formulation for pathologic diagnosis of antibody-mediated rejection in heart transplantation: evolution and current status (2005-2011)
J Heart Lung Transplant
(2011)
Pulmonary hypertension in heart transplantation: discrepant prognostic impact of pre-operative compared with 1-year post-operative right heart hemodynamics
J Heart Lung Transplant
Relation between global left ventricular longitudinal strain assessed with novel automated function imaging and biplane left ventricular ejection fraction in patients with coronary artery disease
J Am Soc Echocardiogr
Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging
J Am Coll Cardiol
Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography
J Am Coll Cardiol
Fulminant acute cellular rejection with negative findings on endomyocardial biopsy
J Heart Lung Transplant
Current and future challenges in therapy for antibody-mediated rejection
J Heart Lung Transplant
Cited by (55)
Relation between global longitudinal strain and acute rejection in pediatric patients within the first-year post heart transplant
2024, Progress in Pediatric CardiologyDonor Left Ventricular Function Assessed by Echocardiographic Strain is a Novel Predictor of Primary Graft Failure After Orthotopic Heart Transplantation
2021, Journal of Cardiothoracic and Vascular AnesthesiaImaging of Cardiac Transplantation: An Overview
2021, Seminars in Nuclear MedicineCardiac Magnetic Resonance Feature Tracking Global Longitudinal Strain and Prognosis After Heart Transplantation
2020, JACC: Cardiovascular ImagingN-octanoyl dopamine is superior to dopamine in protecting graft contractile function when administered to the heart transplant recipients from brain-dead donors
2019, Pharmacological ResearchCitation Excerpt :Donor organ injury induced by brain death and myocardial IRI impairs early graft function, contributing to adverse short- and long-term graft outcome in the recipients. For the success of cardiac transplantation, a fast functional recovery of the transplanted donor heart is essential and an important determinant of the long-term outcome [21]. As profound hemodynamic changes occur during the early phase after transplantation, we focused our investigations on the early phase of reperfusion.
Pro: Myocardial Deformation Imaging Should Be Used Perioperatively for Assessment of Cardiac Function
2019, Journal of Cardiothoracic and Vascular Anesthesia
This work was supported by the South-Eastern Norway Regional Health Authority, the Norwegian Research Council, and the Inger and John Fredriksen Foundation.