Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography detects acute cellular rejection in orthotopic heart transplant recipients: A systematic review and meta‐analysis

2020 ◽  
Vol 37 (2) ◽  
pp. 302-309 ◽  
Author(s):  
Ahmed Elkaryoni ◽  
Ahmed M. Altibi ◽  
Muhammad Shahzeb Khan ◽  
Osama Okasha ◽  
Karim Ellakany ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Meta Analysis ◽  
Global Longitudinal Strain ◽  
Acute Cellular Rejection ◽  
Transplant Recipients ◽  
Orthotopic Heart Transplant ◽  
Heart Transplant Recipients ◽  
Cellular Rejection

scholarly journals P937 Left atrial longitudinal strain as a marker of acute cellular rejection in heart transplant recipients: impact of intervendor variability

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Carnero Montoro ◽  
M Ruiz Ortiz ◽  
S Rodriguez Diego ◽  
M Delgado Ortega ◽  
A M Rodriguez Almodovar ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Intraclass Correlation ◽  
Acute Cellular Rejection ◽  
Transplant Recipients ◽  
Strain And Strain Rate ◽  
Heart Transplant Recipients ◽  
Cellular Rejection ◽  
Sensitive Marker

Abstract Introduction and purpose Preliminary reports suggests that left atrial longitudinal strain (LALS) variables are a sensitive marker of acute cellular rejection (ACR) in heart transplant recipients (HTxR), discriminating between those studies without rejection and those with any grade of rejection. Intervendor variability is a concern in the widespread use of this technique. Our objective was to compare the LALS evaluated by two different softwares. Methods From September 2014 to October 2016 we performed, in 18 consecutive adult HTxR in their first year posttransplantation, serial echocardiographic exams within 3 hours of the routine surveillance endomyocardial biopsies (EMB), in a single centre. Peak average longitudinal strain, and strain rate were measured in the left atrium in the apical four chambers view in all studies, using both softwares, its association with the presence of ACR was investigated, and intervendor variability was evaluated. Results a total of 147 pairs of EMB and echo exams were performed, 65 with no rejection (grade 0R), 82 with any grade of ejection (grades 1R and 2R). Intraclass correlation coeficients for intervendor reproducibility for LALS and LALSR were 0.4 (95%CI 0.26 - 0.57) and 0.3 (95%CI -0.06 - 0.52) respectively. The number of segments evaluable by each software was significantly different. Association of LALS with rejection is shown in the table. Conclusions In this monocentric prospective study, left atrial longitudinal strain variables were found to be a sensitive marker of acute cellular rejection in heart transplant recipients. Although intervendor reproducibility was poor, these results were consistent between both software. Results Software n/N (%)* Variable No ACR ACR≥1 p value Siemens 114/147 (77.5) Peak atrial LS 19.4 ± 7.4 15.5 ± 6.3 0.006 114/147 (77.5) Peak atrial LSR 1.5 ± 0.4 1.3 ± 0.5 0.005 TomTec 131/147 (89.1) Peak atrial LS 19.1 ± 6.2 14.1 ± 5.4 <0.005 131/147 (89.1) Peal atrial LSR 1.0 ± 0.4 0.8 ± 0.3 <0.005 n: number of exams evaluable by each software. N: total numbers of exams. *p = 0.01 for comparison between the proportion of exams evaluable by each software.

3076Individual patient meta-analysis of global longitudinal strain: is one normal range enough?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N D'Elia ◽  
S Caselli ◽  
A E Van Den Bosch ◽  
W Kosmala ◽  
P Lancellotti ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Healthy Individuals ◽  
Normal Range ◽  
Software Changes

Abstract Background Despite over a decade of evidence, uptake of GLS into guidelines and practice has been slow. Age, BP, and software have been reported to influence GLS, and have led to uncertainty about defining the normal range (NR). As there have been software changes since the last meta-analysis, we sought to define NR in the current era. Methods Pubmed, Cochrane, and EMBASE were searched using the keywords “Left Ventricle”, “Normal global longitudinal strain”, and “Speckle tracking Echocardiography” and relevant synonyms from 2011. Studies were included if they reported GLS based on speckle tracking techniques, included at least 20 healthy individuals, and had up to date contact details available. Healthy was defined as lack of known disease. Platforms used included General Electric, Philips, Canon and Tomtec. The authors of 8 of the 12 studies (67% response) provided individual patient data. Linear regression was used to determine predictors of GLS. Results There were 2396 pts, mean age 42 years (range 18–92), weight 66±12kg, height 169±9cm, BSA 1.7±0.2m2, and SBP 120±13 mmHg. Normal range for GLS was 21.0±2.6%. In multivariable analysis age (β=-0.02, p<0.01), weight (β=-0.03, p<0.01), SBP (β=-0.01, p<0.01) and platform were associated with GLS. GLS tends to vary with extremes of age and BP (see Figure 1 and Figure 2). GLS vs Age group Conclusion Extremes of age and BP may lead to low GLS, but generally, GLS is <16% is abnormal. Acknowledgement/Funding None

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