Marciniak A, Eroglu E, Marciniak M, Sirbu C, Herbots L, Droogne W et al. The potential clinical role of ultrasonic strain and strain rate imaging in diagnosing acute rejection after heart transplantation. Eur J Echocardiography 2007; 8:213-221.Web of ScienceCrossrefGoogle Scholar
 Weidemann F, Kowalski M, D’hooge J, Bijnens B, Sutherland GR. Doppler myocardial imaging. A new tool to assess regional inhomogeneity in cardiac function. BasicRes Cardiol 2001; 96:595-605.CrossrefGoogle Scholar
 D’hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 2000; 1:154-170.Google Scholar
 Tugulea S, Ciubotariu R, Colovai AI, Liu Z, Itescu S, Schulman LL et al. New strategies for early diagnosis of heart allograft rejection. Transplantation 1997; 64(6):842-847.PubMedCrossrefGoogle Scholar
 Sutherland GR, Stewart MJ, Groundstroem KW, Moran CM, Fleming A, Guell-Peris FJ et al. Color Doppler myocardial imaging: a new technique for the assessment of myocardial function. J Am Soc Echocardiogr 1994; 7:441-458.Google Scholar
 Stoylen A, Heimdal A, Bjornstad K, Torp HG, Skjaerpe T. Strain rate imaging by ultrasound in the diagnosis of regional dysfunction of the left ventricle. Echocardiography 1999; 16(4):321-329.PubMedCrossrefGoogle Scholar
 Waggoner AD, Bierig SM. Tissue Doppler imaging: a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function. J Am Soc Echocardiogr 2001; 14(12):1143-1152.CrossrefGoogle Scholar
 Sengupta PP, Mohan JC, Pandian NG. Tissue Doppler echocardiography: principles and applications. IndianHeart J 2002; 54(4):368-378.Google Scholar
 Yu CM, Sanderson JE, Marwick TH, Oh JK. Tissue Doppler imaging a new prognosticator for cardiovascular diseases. J Am Coll Cardiol 2007; 20(3):234-243.Google Scholar
 Modesto K.M, Cauduro S, Dispezieri A, Khandheria B, Belohlavek M, Lysyansky P et al. Two-dimensional acoustic pattern derived strain parameters closely correlate with one-dimensional tissue Doppler derived strain measurements. Eur J Echocardiogr 2006; 7:315-321.PubMedCrossrefGoogle Scholar
 Serri K, Reant P, Lafitte M, Berhouet M, le Bouffos V, Roudaut R et al. Global and regional myocardial function quantification by two-dimensional strain. J Am CollCardiol 2006; 47:1175-1181.CrossrefGoogle Scholar
 Reisner SA, Lysyansky P, Agmon Y, Agmon Y, Mutlak D, Lessick J, Friedman Z. Global longitudinal strain: a novel index of left ventricular systolic function. J Am SocEchocardiogr 2004; 17:630-633.CrossrefGoogle Scholar
 Perk G, Tunick PA, Kronzon I. Non-Doppler twodimensional strain imaging by echocardiography - from technical considerations to clinical applications. J Am SocEchocardiogr 2007; 49(19):1903-1914.Google Scholar
 Puleo JA, Aranda JM, Weston MW, Cintron G, French M, Clark L et al. Non-invasive detection of allograft rejection in heart transplant recipients by use of tissue Doppler imaging. J Heart Lung Transplant 1998; 17:176-184.Google Scholar
 Mannaerts HF, Simoons ML, Balk AH, Tijssen J, van der Borden SG, Zondervan PE et al. Pulsed-wave transmitral Doppler do not diagnose moderate acute rejection after heart transplantation. J Heart Lung Transplant 1993; 2(3):411-421.Google Scholar
 Amende I, Simon R, Seegers A, Daniel W, Heublein B, Hetzer R et al. Diastolic dysfunction during acute cardiac allograft rejection. Circulation 1990; 81(3):66-70.Google Scholar
 Bader FM, Islam N, Mehta NA, Worthen N, Ishihara S, Stehlik J et al. Noninvasive diagnosis of cardiac allograft rejection using echocardiography indices of systolic and diastolic function. Transplantation Proceedings 2011: 3877-3881.Web of SciencePubMedGoogle Scholar
 Mankad S, Murani S, Kormos RL, Mandarino WA, Gorcsan J 3rd. Evaluation of the potencial role of color-coded tissue Dopler echocardiography in the detection of allograft rejection in heart transplant recipients. Am Heart J 1999; 138(4 Pt 1):721.CrossrefGoogle Scholar
 Vivekananthan K, Kalapura T, Mehra M, Lavie C, Milani R, Scott R et al. Usefulness of the combined index of systolic and diastolic myocardial performance identify cardiac allograft rejection. Am J Cardiol 2002; 90:517.PubMedCrossrefGoogle Scholar
 Dandel M, Lehmkuhl H, Knosalla C, Hetzer R. Non-Doppler twodimensional strain imaging for early detection of heart transplant recipientswith coronary stenoses. Circulation 2007; 116(16 suppl) II-322.Google Scholar
 Soo A, Maher B, McCarthy J, Nölke L, Wood A, Watson RWG. Pre-operative determination of an individual’s neutrophil response: A potential predictor of early cardiac transplant cellular rejection. J Heart Lung Transplant 2009; 28:1198-1205.Web of ScienceCrossrefGoogle Scholar
 Aguilar P, Mathieu CP, Clerc G, Ethevenot G, Fajraoui M, Mattei S et al. Modulation of natural killer (NK) receptors on NK (CD3-/CD56+), T (CD3+/CD56-) and NKT-like (CD3+/CD56+) Cells after Heart Transplantation. J HeartLung Transplant 2006; 25:200-205.CrossrefGoogle Scholar
 Weigel G, Griesmacher A, Karimi A, Zuckermann AO, Grimm M, Mueller MM. Effect of mycophenolate mofetil therapy on lymphocyte activation in heart transplant recipients. J Heart Lung Transplant 2002; 21:1074-1079.CrossrefGoogle Scholar
 Aharinejad S, Gmeiner M, Rodler S, Thomas A, Lucas T, Laufer G et al. CD4-CD25 regulatory T cell levels are associated with cardiac allograft vasculopathy. J Heart LungTransplant 2010, 29(2):155.Google Scholar
 Uss E, Rowshani AT, Hooibrink B, Lardy NM, van Lier RAW, ten Berge IJM. CD103 is a marker for alloantigen-induced regulatory CD8 T cells. The Journalof Immunology 2006, 177:2775-2783.Google Scholar
 Yuan X, Salama AD, Dong V, Schmitt I, Najafian N, Chandraker A et al. The role of the CD134-CD134 ligand costimulatory pathway in alloimmune responses in vivo. TheJournal of Immunology 2003; 170:2949-2955.Google Scholar
Seminars in Cardiovascular Medicine
The Journal of Lithuanian Heart Association
1 Issue per year
The potential role of ultrasonic strain imaging and immunophenotyping in diagnosing acute rejection after heart transplantation
Background: There has been a continued search for an accurate noninvasive technique for detecting subclinical acute rejection in heart transplant recipients. Ultrasonic deformation imaging - strain/strain rate (SR) - is sensitive in detecting sub-clinical abnormalities in regional myocardial function and could potentially be sensitive tool to detect changes in deformation induced by graft rejection. There is an evidence of the importance of immunophenotyping in determining transplant rejection as well.
Aim: to assess the potential role of cardiac ultrasound velocity/strain imaging and immunological testing (alterations in peripheral blood T-cells subsets activation) in the detection of acute allograft rejection proven by endomyocardial biopsy.
Patients and methods: A retrospective observational study was carried out involving 28 patients (22 men and 6 women) who underwent a total of 167 routine follow up endomyocardial biopsies with correlative cardiac ultrasound and immunophenotyping data. Myocardial velocity derived from pulsed wave tissue Doppler imaging (PW-TDI) was calculated in the longitudinal direction in basal lateral segment of left ventricle (LV) in 4-chamber view and in the radial direction in basal posterior LV segment in long parasternal axis view. Global systolic strain by speckle tracking was calculated in the longitudinal, radial and circumferential directions.
Results: According to the International Society of Heart and Lung Transplantation criteria, 90 biopsies (Group 1) had grade 0, 1R or 2R rejection, and 30 biopsies (Group 2) had grade 3R rejection. The results of the forward selection revealed that the best indicator to predict the rejection was the amount of CD4+/HLA-DR+ cells. Univariate logistic regression analysis showed that global radial systolic strain performs better in terms of receiver-operator-characteristic curves (ROC) than the rest of the measurements (area-under-curve 0.83, where a cut-off value of 32.4% had 91.7% sensitivity and 77.8% specificity).
Conclusions: One of the best non-invasive parameters in the detection of acute sub-clinical rejection appears to be the expression of CD4+/HLA-DR+ cells. Among ultrasound markers the best predictor of acute rejection is global radial systolic strain.