Abstract
AIMS: The aim of this prospective study was to use left ventricular global longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of graft function in relation to acute cellular rejection (ACR) during the first year after heart transplantation (HTX). METHODS AND RESULTS: The study population consisted of 36 patients undergoing HTX from November 2010 until October 2013. Patients were followed by comprehensive echocardiography and biopsies at 2 weeks and 1, 3, 6, and 12 months after HTX. ACRs were classified based on the ISHLT classification (0R-3R). Patients were divided into two groups according to the presence of one or more episodes of biopsy proven ≥grade 2R ACR during follow-up. We found that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were significantly related to ACR burden in a linear regression model. The absolute difference in LV-GLS between patients in the ACR group (-14.4%) and patients in the ACR-free group (-16.8%) was -2.4% (P < 0.01) 12 months after HTX. In the ACR group, patients' LV-GLS did not improve between 1 and 12 months, whereas an improvement of -2.9% was seen in the ACR-free group in this period (P < 0.01). The two groups appeared not to differ in terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE was 15.3 ± 2.8 mm in the ACR-free group vs. 13.2 ± 2.1 mm ACR group, P < 0.05, 12 months after HTX. CONCLUSION: Gradual improvement of longitudinal LV and RV function was seen within the first year after HTX, but the degree of recovery was strongly influenced by ACR episodes.