Pediatr Transplant. 2021 Nov 25;e14195. doi: 10.1111/petr.14195. Epub 2021 Nov 25.

Changes in circumferential strain can differentiate pediatric heart transplant recipients with and without graft rejection.

Pediatric transplantation

Katerina Boucek, Ali Burnette, Heather Henderson, Andrew Savage, Shahryar M Chowdhury

PMID: 34825441 DOI: 10.1111/petr.14195

Abstract

BACKGROUND: Routine surveillance protocols rely heavily on endomyocardial biopsy (EMB) for detection of rejection in pediatric heart transplant recipients. More sensitive echocardiographic tools to assess rejection may help limit the number of EMBs. This study compared changes in left ventricular (LV) strain in patients who had rejection versus those who did not.

METHODS: A single center retrospective review was conducted between 2013 and 2020. Patients were categorized based on rejection history. Echocardiograms were evaluated at the time of 2 consecutive EMBs; in the rejection group, the second echocardiogram was collected at the time of a rejection episode. Conventional measures of LV function and speckle-tracking echocardiography-derived longitudinal (LS) and circumferential strain (CS) were measured.

RESULTS: 17 patients were in the non-rejection group and 17 were in the rejection group (30 total rejection episodes). The rejection group was older at the time of transplant (12.5 vs. 1.3 years, p = .01). A decline in CS was seen in the rejection group at the second echocardiogram [-18.5 (IQR -21.5, -14.6) to -15.7 (IQR -19.8, -13.2)] while CS improved in the non-rejection group [-20.8 (IQR -23.9, -17.8) to -23.9 (IQR -24.9, -20.1)]. This difference in change reached significance (p = .02). A similar pattern was seen in LS that neared significance (p = .06). There was no significant difference in ejection fraction change (p = .24).

CONCLUSIONS: Patients in the non-rejection group displayed improvement in CS between echocardiograms while patients in the rejection group showed subsequent decline. Worsening of LV CS may help identify acute rejection in the early post-transplant period.

© 2021 Wiley Periodicals LLC.

Keywords: acute rejection; biopsy; cardiac transplantation; echocardiography; pediatric transplantation; pediatrics

References

1. Pophal SG, Sigfusson G, Booth KL, et al. Complications of endomyocardial biopsy in children. J Am Coll Cardiol. 1999;34:2105-2110. - PubMed
2. Zinn MD, Wallendorf MJ, Simpson KE, Osborne AD, Kirklin JK, Canter CE. Impact of routine surveillance biopsy intensity on the diagnosis of moderate to severe cellular rejection and survival after pediatric heart transplantation. Pediatr Transplant. 2018;22:e13131. - PubMed
3. Putzer GJ, Cooper D, Keehn C, Asante-Korang A, Boucek MM, Boucek RJ Jr. An improved echocardiographic rejection-surveillance strategy following pediatric heart transplantation. J Heart Lung Transplant. 2000;19:1166-1174. - PubMed
4. Poterucha JT, Kutty S, Lindquist RK, Li L, Eidem BW. Changes in left ventricular longitudinal strain with anthracycline chemotherapy in adolescents precede subsequent decreased left ventricular ejection fraction. J Am Soc Echocardiogr. 2012;25:733-740. - PubMed
5. Colvin MM, Cook JL, Chang P, et al. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management: a scientific statement from the American Heart Association. Circulation. 2015;131:1608-1639. - PubMed
6. Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24:1710-1720. - PubMed
7. Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19:1413-1430. - PubMed
8. Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23:465-495;quiz 576-7. - PubMed
9. Pieper GM, Shah A, Harmann L, Cooley BC, Ionova IA, Migrino RQ. Speckle-tracking 2-dimensional strain echocardiography: a new noninvasive imaging tool to evaluate acute rejection in cardiac transplantation. J Heart Lung Transplant. 2010;29:1039-1046. - PubMed
10. Clemmensen TS, Logstrup BB, Eiskjaer H, Poulsen SH. Changes in longitudinal myocardial deformation during acute cardiac rejection: the clinical role of two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr. 2015;28:330-339. - PubMed
11. Mingo-Santos S, Monivas-Palomero V, Garcia-Lunar I, et al. Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. J Am Soc Echocardiogr. 2015;28:1149-1156. - PubMed
12. Sato T, Kato TS, Komamura K, et al. Utility of left ventricular systolic torsion derived from 2-dimensional speckle-tracking echocardiography in monitoring acute cellular rejection in heart transplant recipients. J Heart Lung Transplant. 2011;30:536-543. - PubMed
13. Tseng AS, Gorsi US, Barros-Gomes S, et al. Use of speckle-tracking echocardiography-derived strain and systolic strain rate measurements to predict rejection in transplant hearts with preserved ejection fraction. BMC Cardiovasc Disord. 2018;18:241. - PubMed
14. Sehgal S, Blake JM, Sommerfield J, Aggarwal S. Strain and strain rate imaging using speckle tracking in acute allograft rejection in children with heart transplantation. Pediatr Transplant. 2015;19:188-195. - PubMed
15. Engelhardt K, Das B, Sorensen M, Malik S, Zellers T, Lemler M. Two-dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection. Echocardiography. 2019;36:1876-1883. - PubMed
16. Kailin JA, Miyamoto SD, Younoszai AK, Landeck BF. Longitudinal myocardial deformation is selectively decreased after pediatric cardiac transplantation: a comparison of children 1 year after transplantation with normal subjects using velocity vector imaging. Pediatr Cardiol. 2012;33:749-756. - PubMed
17. Godown J, Dodd DA, Stanley M, et al. Changes in left ventricular strain parameters following pediatric heart transplantation. Pediatr Transplant. 2018;22:e13166. - PubMed
18. Lunze FI, Colan SD, Gauvreau K, et al. Cardiac allograft function during the first year after transplantation in rejection-free children and young adults. Circ Cardiovasc Imaging. 2012;5:756-764. - PubMed
19. Mahle WT, Cardis BM, Ketchum D, Vincent RN, Kanter KR, Fyfe DA. Reduction in initial ventricular systolic and diastolic velocities after heart transplantation in children: improvement over time identified by tissue Doppler imaging. J Heart Lung Transplant. 2006;25:1290-1296. - PubMed
20. Webber SA, Naftel DC, Parker J, et al. Late rejection episodes more than 1 year after pediatric heart transplantation: risk factors and outcomes. J Heart Lung Transplant. 2003;22:869-875. - PubMed
21. Dipchand AI. Current state of pediatric cardiac transplantation. Ann Cardiothorac Surg. 2018;7:31-55. - PubMed
22. Kirklin JK, Naftel DC, Bourge RC, et al. Rejection after cardiac transplantation. A time-related risk factor analysis. Circulation. 1992;86:II236-II241. - PubMed

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