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Temporal changes in left ventricular strain with the development of rejection in paediatric heart transplant recipients

Published online by Cambridge University Press:  17 June 2019

Justin Godown Open the ORCID record for Justin Godown [Opens in a new window] ,
William A. McEachern ,
Debra A. Dodd ,
Michael Stanley ,
Corey Havens ,
Meng Xu ,
James C. Slaughter ,
David W. Bearl  and
Jonathan H. Soslow Open the ORCID record for Jonathan H. Soslow [Opens in a new window]
Justin Godown*
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
William A. McEachern
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Debra A. Dodd
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Michael Stanley
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Corey Havens
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Meng Xu
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
James C. Slaughter
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
David W. Bearl
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Jonathan H. Soslow
Affiliation:
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
*
Author for correspondence: Justin Godown, MD, Vanderbilt University, Monroe Carell Jr. Children’s Hospital, Division of Pediatric Cardiology, 2200 Children’s Way, Suite 5230 DOT, Nashville, TN 37232-9119, USA. Tel: (615) 322-7447. Email: [email protected]
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Abstract

Introduction:

Myocardial strain measurements are increasingly used to detect complications following heart transplantation. However, the temporal association of these changes with allograft rejection is not well defined. The aim of this study was to describe the evolution of strain measurements prior to the diagnosis of rejection in paediatric heart transplant recipients.

Methods:

All paediatric heart transplant recipients (2004–2015) with at least one episode of acute rejection were identified. Longitudinal and circumferential strain measurements were assessed at the time of rejection and retrospectively on all echocardiograms until the most recent negative biopsy. Smoothing technique (LOESS) was used to visualise the changes of each variable over time and estimate the time preceding rejection at which alterations are first detectable.

Results:

A total of 58 rejection episodes were included from 37 unique patients. In the presence of rejection, there were decrements from baseline in global longitudinal strain (−18.2 versus −14.1), global circumferential strain (−24.1 versus −19.6), longitudinal strain rate (−1 versus −0.8), circumferential strain rate (−1.3 versus −1.1), peak longitudinal early diastolic strain rate (1.3 versus 1), and peak circumferential early diastolic strain rate (1.5 versus 1.3) (p<0.01 for all). The earliest detectable changes occurred 45 days prior to rejection with simultaneous alterations in myocardial strain and ejection fraction.

Conclusions:

Changes in graft function can be detected non-invasively prior to the diagnosis of rejection. However, changes in strain occur concurrently with a decline in ejection fraction. Strain measurements aid in the non-invasive detection of rejection, but may not facilitate earlier diagnosis compared to more traditional measures of ventricular function.

Keywords

Paediatricheart transplantstrainrejection
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 954 - 959
Copyright
© Cambridge University Press 2019 

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