SPC365

Global longitudinal strain and myocardial work as a novel tool for acute cellular rejection prediction in heart transplant patients

Session: Comunicações Orais - Sessão 14 - Transplante cardíaco
Speaker: Francisco Barbas de Albuquerque

Congress: CPC 2023
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.8 Cardiovascular Surgery - Transplantation
Session Type: Comunicações Orais
FP Number: ---
Authors: Francisco Barbas De Albuquerque; Ana Raquel Carvalho Santos; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira da Silva; Valdemar Gomes; Lídia de Sousa; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In heart transplanted (HT) patients, endomyocardial biopsy (EMB) remains the gold-standard for acute cellular rejection (ACR) detection. Non-invasive measurements to detect ACR are scarce. Global longitudinal strain (GLS) and myocardial work (MW) have emerged as a novel tool for myocardial function assessment. Whether GLS and MW parameters can confidently predict ACR in HT patients is not stablished.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To determine whether GLS and MW parameters by speckle tracking echocardiography can predict ACR in HT patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of consecutive patients submitted to EMB between February 2016 and November 2022, who performed transthoracic echocardiography (TTE) at the same day. Significant ACR was defined as &ge; 2R on EMB, according to the ISHLT 2004 grading. The left ventricular (LV) GLS of each corresponding EMB were calculated&nbsp;by speckle tracking technique. Non-invasive blood pressure was measured and registered during TTE performance. MW parameters, namely global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were automatically generated by the software.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">GLS, GWI, GCW, GWW and GWE values were assessed by area under curve (AUC) of Receiving Operator Curves (SPSS&reg;) for the prediction of ACR. Statistical differences with a <em>p-value</em> &lt; 0.05 were considered significant.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">From a total of 189 EMB during the study period, 113 entered the primary analysis. Significant ACR was observed in 5 (4.4%) patients. Mean age was 49 years, 78% were male, mean left ventricular ejection fraction was 59 &plusmn; 10% and mean systolic blood pressure was 129 &plusmn; 18 mmHg.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean GLS (%) was -13 &plusmn; 3, mean GWI (mmHg%) was 461 &plusmn; 397, mean GCW (mmHg%) was 1532 &plusmn; 450, mean GWW (mmHg%) was 160 &plusmn; 112 and mean GWE (%) 89 &plusmn; 9.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AUC results of GLS and MW parameters are depicted in Table 1. GLS (<em>p</em>=0.003), GCW (<em>p</em>=0.003) and GWI (<em>p</em>=0.003) were significantly associated with ACR, while GWW and GWE were not.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ACR did not occur for GLS values &lt; -11.4% as its sensitivity (S) was 100% and specificity (Sp) was 75%. GCW &gt; 1069 mmHg% had a S of 80% and a Sp of 90%, and GWI &gt; 721 mmHg% had a S of 80% and Sp of 88%. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Non-invasive ACR detection remains a clinical challenge. This study demonstrates that LV function assessment by speckle tracking echocardiography techniques, namely GLS and MW might be very useful in HT patients&rsquo; clinical approach. In our population, GLS ruled out ACR for values below -11.4%. Furthermore, GWI and GCW were significantly associated with ACR, which might suggest subclinical LV involvement in the rejection process. This techniques shall be done routinely in HT patients. More studies addressing this issue are needed to draw more robust conclusions.</span></span></p>