Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Patient Characteristics
3.2. Invasive Diagnostics in OHT Follow-Up
3.3. Mortality, AR and CAV
3.4. Sm Course after OHT
3.5. Predictive Value of Sm
3.6. Prognostic Value of Sm
4. Discussion
Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Recipient | |
Age at OHT | 46.2 (±11.4) |
Sex (male) | 127 (76.5) |
BMI in kg/m² | 25.2 (±4.0) |
Waiting list status | |
Highly urgent | 146 (88.0) |
Urgent (until February 2011) | 4 (2.4) |
Transplantable | 16 (9.6) |
Diagnosis leading to OHT | |
DCM | 114 (68.7) |
HCM | 4 (2.4) |
RCM | 0 |
ARVC | 3 (1.8) |
IHD | 35 (21.1) |
Other * | 10 (6.0) |
Previous VAD | 84 (50.6) |
LVAD | 78 (47.0) |
RVAD | 1 (0.6) |
BVAD | 6 (3.6) |
Concomitant disease | |
CKD | 115 (69.3) |
DM | 26 (15.7) |
Type 1 | 4 (2.4) |
Type 2 | 22 (13.3) |
HLP | 64 (38.6) |
Former smoker | 38 (22.9) |
Donor | |
Age at donation | 40.8 (±14.1) |
Sex (male) | 107 (64.5) |
BMI in kg/m² | 25.2 (±3.7) |
Echocardiography | |
LV hypertrophy | 12 (7.2) |
Concomitant disease | |
Hypertension | 22 (13.3) |
CAD | 2 (1.2) |
DM | 6 (3.6) |
Former smoker | 26 (15.7) |
Alcohol abuse | 16 (9.6) |
Drug abuse † | 7 (4.2) |
Cardiopulmonary resuscitation | 20 (12.0) |
Transplantation | |
Combined OHT | |
Heart–kidney | 3 (1.8) |
Ischemic time in min | 259.9 (±63.3) |
ICU stay in days | 26.7 (±36.3) |
Hospital stay in days | 62.3 (±50.7) |
Inotropic support in days | 8 (5–12) |
Mechanical ventilation in days | 5 (2–18) |
GFR at discharge in ml/min | |
>90 | 67 (40.2) |
60–89 | 35 (21.1) |
40–59 | 22 (13.3) |
30–44 | 19 (11.4) |
15–29 | 8 (4.8) |
RRT | 16 (9.6) |
Immunosuppression induction | |
Cyclosporine | 162 (97.2) |
Tacrolimus | 4 (2.4) |
Mycophenolate mofetil | 9 (5.4) |
Methylprednisolone | 166 (100.0) |
Antithymocyte globulin | 100 (60.2) |
Other § | 4 (2.4) |
Immunosuppression at discharge | |
Cyclosporine | 92 (55.4) |
Tacrolimus | 71 (42.8) |
Everolimus | 19 (11.4) |
Mycophenolate mofetil | 132 (79.5) |
Methylprednisolone | 164 (98.8) |
Unknown | 2 (1.2) |
CAV Grade | ISHLT CAV1 n = 5 | ISHLT CAV2 n = 4 | ISHLT CAV3 n = 20 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Pre | CAV1 | Change | Pre | CAV2 | Change | Pre | CAV3 | Change | (CI) p value | |
Sm rad cm/s | 10.7 | 9.9 | −0.8 | 11.0 | 10.3 | 0.8 | 10.5 | 9.3 | 1.3 | (0.23–2.43) |
(±1.2) | (±0.7) | (±1.69) | (±2.2) | (±1.5) | (±2.2) | (±1.9) | (±2.9) | (±2.5) | 0.017 | |
Sm long cm/s | 11.0 | 9.2 | −1.8 | 10.8 | 10.8 | 0 | 10.6 | 9.5 | 1.4 | (0.21–2.66) |
(±1.4) | (±0.7) | (±1.3) | (±2.2) | (±2.2) | (±2.5) | (±2.2) | (±2.6) | (±2.8) | 0.021 | |
LV-EF % | 60.0 | 56.0 | −4.0 | 58.8 | 55.5 | −3.75 | 56.9 | 52.1 | 4.8 | (0.42–9.18) |
(±3.2) | (±11.6) | (±8.6) | (±4.1) | (±3.5) | (±1.1) | (±6.7) | (±12.0) | (±10.0) | 0.031 | |
ACR grade | ISHLT 1R n = 84 | ISHLT 2R n = 13 | ISHLT 3R n = 8 | |||||||
pre | 1R | change | (CI) p value | pre | 2R | change | pre | 3R | change | |
Sm rad cm/s | 11.3 | 9.6 | −1.7 | (1.32–2.08) | 11.3 | 9.1 | −1.9 | 11.4 | 9.4 | −2.6 |
(±2.0) | (±2.0) | (±1.8) | <0.001 | (±1.7) | (±2.4) | (±2.3) | (±2.1) | (±2.1) | (±3.0) | |
Sm long cm/s | 11.8 | 10.0 | −2.0 | (1.66–2.34) | 11.7 | 9.1 | −2.3 | 11.9 | 9.1 | −3.4 |
(±1.7) | (±2.4) | (±1.6) | <0.001 | (±1.8) | (±2.9) | (±2.4) | (±1.8) | (±1.8) | (±1.9) | |
LV-EF % | 62.6 | 57.9 | −5.3 | (3.85–6.75) | 60.4 | 53.8 | −7.1 | 65.0 | 54.4 | −10.6 |
(±5.8) | (±8.8) | (±6.8) | <0.001 | (±4.0) | (±12.7) | (±16.2) | (±3.5) | (±14.5) | (±13.3) |
ISHLT AMR n = 65 | ||||
---|---|---|---|---|
Pre | AMR | Change (%) | (CI) p Value | |
Sm rad cm/s | 11.7 (±1.9) | 10.1 (±2.1) | −1.6 (±1.9) | (0.77–2.43) <0.001 |
Sm long cm/s | 11.9 (±1.5) | 10.3 (±2.0) | −1.8 (±2.0) | (0.92–2.67) <0.001 |
LV-EF % | 60.8 (±6.4) | 56.5 (±9.8) | −4.5 (±7.7) | (1.13–7.87) 0.009 |
Hazard Ratio | 95% CI | p Value | |
---|---|---|---|
Sm long, cm/s | 0.74 | 0.58–0.95 | 0.016 |
Sm rad, cm/s | 0.77 | 0.63–0.93 | 0.008 |
IVSd per mm | 0.94 | 0.72–1.21 | 0.607 |
LV-EF, % | 1.0 | 0.95–1.05 | 0.968 |
Sm long ≥ 10 cm/s | 0.34 | 0.14–0.84 | 0.019 |
Sm long < 10 cm/s | 2.92 | 1.19–7.18 | 0.019 |
Sm rad ≥ 9 cm/s | 0.31 | 0.11–0.83 | 0.020 |
Sm rad < 9 cm/s | 3.24 | 1.2–8.76 | 0.020 |
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Just, I.A.; Guelfirat, M.; Leser, L.; Uecertas, A.; Kopp Fernandes, L.; Godde, M.; Merke, N.; Stawowy, P.; Hennig, F.; Knosalla, C.; et al. Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation. Life 2021, 11, 1206. https://doi.org/10.3390/life11111206
Just IA, Guelfirat M, Leser L, Uecertas A, Kopp Fernandes L, Godde M, Merke N, Stawowy P, Hennig F, Knosalla C, et al. Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation. Life. 2021; 11(11):1206. https://doi.org/10.3390/life11111206
Chicago/Turabian StyleJust, Isabell A., Meryem Guelfirat, Laura Leser, Ata Uecertas, Laurenz Kopp Fernandes, Maren Godde, Nicolas Merke, Philipp Stawowy, Felix Hennig, Christoph Knosalla, and et al. 2021. "Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation" Life 11, no. 11: 1206. https://doi.org/10.3390/life11111206