Elsevier

The American Journal of Cardiology

Volume 137, 15 December 2020, Pages 63-70
The American Journal of Cardiology

Longitudinal Strain and Strain Rate for Estimating Left Ventricular Filling Pressure in Heart Transplant Recipients

https://doi.org/10.1016/j.amjcard.2020.09.037Get rights and content

Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic, and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pretransplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared with pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8 ± 4.3 mm Hg (range: 4 to 25 mm Hg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e’), were different between studies with normal (n = 47) and elevated PCWP (n = 27). Area Under Curve for GLS (0.932*), E/e’SR (0.849*), and systolic SR (0.848*) (*p <0.0001) were more accurate than traditional parameters for predicting PCWP>12 mm Hg. GLS, systolic SR and E/e’SR remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e’ was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e'SR tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e’SR provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP.

Section snippets

Methods

All OHT patients followed from January 2017 to December 2019 at our center were included consecutively at the time of surveillance endomyocardial biopsies regardless of symptoms according to our institutional follow-up protocol.9 Patients were excluded if they had biatrial anastomoses (n = 2) or inadequate image quality for strain analysis (n = 2). All were in normal sinus rhythm, had no conduction abnormality, pericardial effusion or more than mild valvular disease. We excluded examinations

Results

A total of 74 data sets were obtained from 50 patients after OHT. Patients’ characteristics are presented in Table 1. Twenty-four patients had 2 studies at different time points with different hemodynamic measurements. In all, PCWP was 11.8 ± 4.3 mm Hg (range 4 to 25), systolic PAP 27.2 ± 7.9 mm Hg (range 8 to 59), mean PAP 17.1 ± 5.9 mm Hg (range 7 to 47), right atrial pressure 5.7 ± 4.0 mm Hg (range 1 to 18). In the pooled dataset LV EF, GLS, SSR, e’SR were significantly decreased while LV

Discussion

The main findings of the present study can be summarized as follows: SSR, e’SR, E/e’SR, and GLS are worsening in OHT patients with elevated LVFP and have clearly stronger diagnostic performance than traditional parameters of diastolic dysfunction, even though E/e’ performs well to predict elevated LVFP in native failing hearts of the same patients. Moreover, E/e’SR and GLS are associated with LVFP independently from LV EF, EDVi and allograft vasculopathy. Finally, changes in GLS and E/e'SR

Authors contribution

All authors have read and approved the manuscript. All authors have access to the full dataset. The authors have no conflict of interest related to this manuscript.

Dr Colak took part in reviewing echocardiographic data and drafting the manuscript. Dr Muderrisoglu contributed to the design and revision of the manuscript, Dr Eroglu and Dr Pirat took part in reviewing echocardiographic data, Dr Aydınalp took part in reviewing catheter data, Dr Sezgin took part in final approval and Dr Sade took

Disclosures

None of the authors have anything to disclose.

Declaration of Interest

The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

References (30)

Cited by (5)

All financial support related to this study is provided by the University of Baskent, KA 13/03.

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