Clinical Investigation
Heart Transplantation
Early Postoperative Left Ventricular Function by Echocardiographic Strain is a Predictor of 1-Year Mortality in Heart Transplant Recipients

https://doi.org/10.1016/j.echo.2012.05.010Get rights and content

Background

Left ventricular (LV) function can be accurately assessed using two-dimensional speckle-tracking echocardiography. The association between reduced LV global longitudinal strain (LVGLS) magnitude and risk for mortality in heart transplant recipients is unclear. The aim of this study was to test the hypothesis that LVGLS could predict 1-year mortality in heart transplant recipients.

Methods

A total of 176 consecutive adult primary single-organ orthotopic heart transplant recipients were retrospectively evaluated. Of these, 167 had acceptable echocardiographic image quality and were included in the study. N-terminal pro–B-type natriuretic peptide, creatinine, C-reactive protein, and invasive hemodynamic parameters were measured, and echocardiography was performed 1 to 3 weeks after heart transplantation. LVGLS was averaged from regional strain in 16 LV segments.

Results

During the first year, 15 patients (9%) died 86 ± 72 days after heart transplantation. LVGLS and LV ejection fraction were decreased in magnitude in nonsurvivors (P < .05). They were older and had higher donor ages. Mean pulmonary capillary wedge pressures were similar in the two groups, while all other hemodynamic parameters were increased in nonsurvivors (P < .05). LVGLS was the only significant (P = .02) noninvasive independent predictor, with a hazard ratio of 1.42 (95% confidence interval, 1.07–1.88; P = .02) per 1% decrease in strain magnitude, while pulmonary vascular resistance was a significant (P < .001) invasive predictor, with a hazard ratio of 3.98 (95% confidence interval, 2.01–7.87) of 1-year mortality in multivariate Cox regression analysis.

Conclusions

Reduced LV function and increased pulmonary vascular resistance are related to poor prognosis in heart transplant recipients. Early assessment of LVGLS might be a noninvasive predictor of 1-year mortality in these patients.

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)

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This work was supported by the South-Eastern Norway Regional Health Authority, the Norwegian Research Council, and the Inger and John Fredriksen Foundation.

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