Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

Background: Despite the risk for complications, allograft surveillance after orthotopic heart transplantation (OHT) is performed by cardiac catheterization and biopsies. We investigated the diagnostic and prognostic value of a TDI-derived systolic wall motion analysis of the posterobasal wall of the...

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Autores principales:	Isabell A. Just, Meryem Guelfirat, Laura Leser, Ata Uecertas, Laurenz Kopp Fernandes, Maren Godde, Nicolas Merke, Philipp Stawowy, Felix Hennig, Christoph Knosalla, Volkmar Falk, Jan Knierim, Felix Schoenrath
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	heart transplantation rejection surveillance echocardiography Science Q
Acceso en línea:	https://doaj.org/article/3c2d7632850c46129fa8219c88dffa3b
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spelling	oai:doaj.org-article:3c2d7632850c46129fa8219c88dffa3b2021-11-25T18:11:11ZDiagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation10.3390/life111112062075-1729https://doaj.org/article/3c2d7632850c46129fa8219c88dffa3b2021-11-01T00:00:00Zhttps://www.mdpi.com/2075-1729/11/11/1206https://doaj.org/toc/2075-1729Background: Despite the risk for complications, allograft surveillance after orthotopic heart transplantation (OHT) is performed by cardiac catheterization and biopsies. We investigated the diagnostic and prognostic value of a TDI-derived systolic wall motion analysis of the posterobasal wall of the left ventricle (Sm) as a screening modality in OHT aftercare. Methods: We examined data of 210 eligible patients who underwent OHT between 2010 and 2020. Forty-four patients who had died within the initial hospital stay were excluded. For 166 patients, baseline and follow-up data were analyzed. The mean age at OHT was 46.2 (±11.4) years; 76.5% were male. Results: Within the observational period, 22 (13.3%) patients died. In total, 170 episodes of acute cellular or humoral rejections occurred (84 ISHLT1R; 13 ISHLT2R; 8 ISHLT3R; 65 AMR), and 29 catheterizations revealed cardiac allograft vasculopathy (5 CAV1; 4 CAV2; 20 CAV3). Individual Sm radial/longitudinal remained stable within the follow-up period (11.5 ± 2.2 cm/s; 10.9 ± 2.1 cm/s). Patients with acute rejections and CAV3 showed significant Sm radial/longitudinal reductions (AMR1: 1.6 ± 1.9 cm/s, confidence interval (CI) 0.77–0.243, <i>p</i> < 0.001; 1.8 ± 2.0 cm/s, CI 0.92–0.267, <i>p</i> < 0.001. ISHLT1R: 1.7 ± 1.8 cm/s, CI 1.32–2.08, <i>p</i> < 0.001; 2.0 ± 1.6 cm/s, CI 1.66–2.34, <i>p</i> < 0.001. CAV3: 1.3 ± 2.5 cm/s, CI 0.23–2.43, <i>p</i> < 0.017; 1.4 ± 2.8 cm/s, CI 0.21–2.66, <i>p</i> < 0.021). Lower Sm was associated with a threefold increase in all-cause mortality (hazard ratio (HR) 3.24, CI 1.2–8.76, <i>p</i> = 0.020; HR 2.92, CI 1.19–7.18, <i>p</i> = 0.019). Overall, Sm-triggered surveillance led to 0.75 invasive diagnostics per patient post-OHT year. Conclusions: Sm remained stable in the post-OHT course. Reductions indicated ISHLT1R, AMR1 and CAV3 and were associated with higher all-cause mortality. Sm-triggered surveillance may be referred to as a safe, high-yield screening modality in OHT aftercare.Isabell A. JustMeryem GuelfiratLaura LeserAta UecertasLaurenz Kopp FernandesMaren GoddeNicolas MerkePhilipp StawowyFelix HennigChristoph KnosallaVolkmar FalkJan KnierimFelix SchoenrathMDPI AGarticleheart transplantationrejectionsurveillanceechocardiographyScienceQENLife, Vol 11, Iss 1206, p 1206 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	heart transplantation rejection surveillance echocardiography Science Q
spellingShingle	heart transplantation rejection surveillance echocardiography Science Q Isabell A. Just Meryem Guelfirat Laura Leser Ata Uecertas Laurenz Kopp Fernandes Maren Godde Nicolas Merke Philipp Stawowy Felix Hennig Christoph Knosalla Volkmar Falk Jan Knierim Felix Schoenrath Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
description	Background: Despite the risk for complications, allograft surveillance after orthotopic heart transplantation (OHT) is performed by cardiac catheterization and biopsies. We investigated the diagnostic and prognostic value of a TDI-derived systolic wall motion analysis of the posterobasal wall of the left ventricle (Sm) as a screening modality in OHT aftercare. Methods: We examined data of 210 eligible patients who underwent OHT between 2010 and 2020. Forty-four patients who had died within the initial hospital stay were excluded. For 166 patients, baseline and follow-up data were analyzed. The mean age at OHT was 46.2 (±11.4) years; 76.5% were male. Results: Within the observational period, 22 (13.3%) patients died. In total, 170 episodes of acute cellular or humoral rejections occurred (84 ISHLT1R; 13 ISHLT2R; 8 ISHLT3R; 65 AMR), and 29 catheterizations revealed cardiac allograft vasculopathy (5 CAV1; 4 CAV2; 20 CAV3). Individual Sm radial/longitudinal remained stable within the follow-up period (11.5 ± 2.2 cm/s; 10.9 ± 2.1 cm/s). Patients with acute rejections and CAV3 showed significant Sm radial/longitudinal reductions (AMR1: 1.6 ± 1.9 cm/s, confidence interval (CI) 0.77–0.243, <i>p</i> < 0.001; 1.8 ± 2.0 cm/s, CI 0.92–0.267, <i>p</i> < 0.001. ISHLT1R: 1.7 ± 1.8 cm/s, CI 1.32–2.08, <i>p</i> < 0.001; 2.0 ± 1.6 cm/s, CI 1.66–2.34, <i>p</i> < 0.001. CAV3: 1.3 ± 2.5 cm/s, CI 0.23–2.43, <i>p</i> < 0.017; 1.4 ± 2.8 cm/s, CI 0.21–2.66, <i>p</i> < 0.021). Lower Sm was associated with a threefold increase in all-cause mortality (hazard ratio (HR) 3.24, CI 1.2–8.76, <i>p</i> = 0.020; HR 2.92, CI 1.19–7.18, <i>p</i> = 0.019). Overall, Sm-triggered surveillance led to 0.75 invasive diagnostics per patient post-OHT year. Conclusions: Sm remained stable in the post-OHT course. Reductions indicated ISHLT1R, AMR1 and CAV3 and were associated with higher all-cause mortality. Sm-triggered surveillance may be referred to as a safe, high-yield screening modality in OHT aftercare.
format	article
author	Isabell A. Just Meryem Guelfirat Laura Leser Ata Uecertas Laurenz Kopp Fernandes Maren Godde Nicolas Merke Philipp Stawowy Felix Hennig Christoph Knosalla Volkmar Falk Jan Knierim Felix Schoenrath
author_facet	Isabell A. Just Meryem Guelfirat Laura Leser Ata Uecertas Laurenz Kopp Fernandes Maren Godde Nicolas Merke Philipp Stawowy Felix Hennig Christoph Knosalla Volkmar Falk Jan Knierim Felix Schoenrath
author_sort	Isabell A. Just
title	Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
title_short	Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
title_full	Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
title_fullStr	Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
title_full_unstemmed	Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
title_sort	diagnostic and prognostic value of a tdi-derived systolic wall motion analysis as a screening modality for allograft rejection after heart transplantation
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/3c2d7632850c46129fa8219c88dffa3b
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Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

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