Two‐dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection.
Background: Acute rejection is an important cause of morbidity and mortality in the pediatric heart transplant (HT) population. A reliable noninvasive method for diagnosis of clinical rejection could substantially reduce these negative outcomes. Objective: Evaluate left ventricular (LV) global longi...
| Publicado en: | Echocardiography Vol. 36; no. 10; pp. 1876 - 1884 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Oct2019
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139328305&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139328305 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07422822 GSE jtl: Echocardiography issn: 07422822 maglogo: Y pubinfo: dt: Oct2019 vid: 36 iid: 10 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 139328305 139328305 139328305 10.1111/echo.14481 139328305 ppf: 1876 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Two‐dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection. aug: au: Engelhardt, Kevin Das, Bibhuti Sorensen, Matthew Malik, Sadia Zellers, Thomas Lemler, Matthew affil: Department of Child Health, Division of Cardiac Intensive Care, Phoenix Children's Hospital, University of Arizona College of Medicine Phoenix, Phoenix AZ, USA sug: subj: Heart Transplantation Transplant Recipients Echocardiography Methods Heart Ventricle, Left Ultrasonography Ventricular Function, Left Evaluation Systole Evaluation Graft Rejection Evaluation Sensitivity and Specificity Pediatric Care Human Prospective Studies Biopsy Methods Immunosuppression Two-Way Analysis of Variance Noninvasive Procedures Methods ab: Background: Acute rejection is an important cause of morbidity and mortality in the pediatric heart transplant (HT) population. A reliable noninvasive method for diagnosis of clinical rejection could substantially reduce these negative outcomes. Objective: Evaluate left ventricular (LV) global longitudinal strain (GLS), and global circumferential strain (GCS) as early noninvasive indicators of acute pediatric HT rejection. Methods: An 18‐month prospective cohort study involving 61 patients evaluated absolute change in peak global systolic strain (GLS and GCS) from enrollment (baseline) to next planned clinical encounter (follow‐up) or rejection. Acute rejection defined as a biopsy of grade ≥ 2R or treatment with enhanced immunosuppression by the transplant team, blinded to strain analysis. Two patient cohorts three months post HT without evidence of rejection at enrollment were identified. The study cohort experienced rejection. The control cohort remained free from rejection on follow‐up. Two‐way analysis of variance (ANOVA) models evaluated change in GLS and GCS by cohort group and time. Results: Applying exclusion criteria, 51 patients enrolled in the control cohort and 10 in the study cohort. The study cohort's mean GLS declined 33% from baseline to rejection (P < .001) and mean GCS declined 16.6% (P = .021). No significant change from baseline to follow‐up was seen in the control cohort. A threshold absolute GLS value of 16.1% identified acute rejection with 100% sensitivity and 98% specificity (Likelihood Ratio, [LR] 51). Conclusion: Noninvasive global longitudinal strain was sensitive and specific in the identification of acute clinical rejection in pediatric HT recipients. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|