Comparative Analysis of Conventional and Speckle Tracking Echocardiographic Variables between Patients with Unrejected Heart Transplants and Healthy Individuals

Dall’Orto, Aline Oliveira Martins Campo; Otto, Maria Estefania; Leite, Simone Ferreira; Maurício Filho, Marco Antônio Freitas de Queiroz; Martins, Natália Taveira; Araújo, Samuel Rabelo; Almeida, Soraya Vasconcelos; Brizida, Luiza Valle Oliveira; Atik, Fernando Antibas

doi:10.36660/abc.20230681

Brasil

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Original Article • Arq. Bras. Cardiol. 121 (8) • July 2024 • https://doi.org/10.36660/abc.20230681i linkcopy

Comparative Analysis of Conventional and Speckle Tracking Echocardiographic Variables between Patients with Unrejected Heart Transplants and Healthy Individuals

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Echocardiography is essential for the assessment of patients with heart transplants. However, normal values in such individuals are not clearly defined.

Objectives To compare conventional echocardiographic and speckle tracking variables between patients with unrejected heart transplants and healthy individuals.

Methods : A prospective study was conducted with adult patients having undergone heart transplantation at least one year earlier and submitted to endomyocardial biopsy followed by transthoracic echocardiogram (TTE). Conventional TTE measures and mechanical heart strain assessments using speckle tracking were performed and the results were compared to those of a group of healthy volunteers. Statistical significance was set at 5% (p < 0.05).

Results Thirty-six transplant patients without rejection were analyzed and compared to 30 healthy individuals. Chagas disease was the main reason for transplantation. Lower left ventricular global longitudinal strain expressed in absolute values was found (11.99% in transplant patients vs. 20.60% in controls; p <0.0001), right ventricular free wall longitudinal strain (16.67% in transplant patients vs. 25.50% in controls; p <0.0001) and myocardial work indices (p < 0.0001) as well as a larger size of the left atrium (38.17 ml/m2 in transplant patients vs. 18.98 ml/m2 in controls; p <0.0001) and greater mass and relative wall thickness (p <0.0001).

Conclusion Stable patients having undergone heart transplants without rejection have differences concerning echocardiographic variables compared to healthy individuals. These findings indicate that conventional echocardiographic measures and heart mechanics are altered in transplant patients even in the absence of rejection. Such findings are relevant to the clinical context and follow-up of the patient.

Heart Transplantation; Echocardiography; Ventricular Function

Clinical Characteristic	Transplanted without rejection (n=36)				Control (n=30)				p-value

	Mean or Median	SD/ QR	QT 1	QT 3	Mean or Median	SD/ QR	QT 1	QT 3
Age (years)	52.50	12.50	44.00	56.50	46.00	7.00	44.00	51.00	0.2450^†
Feminine Gender	17 (40.48%)	-	-	-	25 (59.52%)	-	-	-	0.2826^‡
SBP (mmHg)	122.00	31.00	111.00	142.00	117.00	17.00	111	128	0.1910^†
DBP (mmHg)	83.33	16.94	-	-	69.80	10.15	-	-	0.0002^*
HR (bpm)	83.61	13.97	-	-	75.17	9.55	-	-	0.0051^*
Height (cm)	164.00	13.00	158.00	171.00	165.50	17.00	158	175	0.5706^†
Weight (kg)	60.75	10.01	-	-	72.86	11.87	-	-	<0.0001^*
BS (m²)	1.66	0.15	-	-	1.80	0.22	-	-	0.0046^*
BMI (cm²/kg)	21.59	3.86	20.26	24.12	26.18	2.92	20.26	24.12	<0.0001^†

Variables	N
Interval between heart transplant and biopsy (days)	70
Quartil 0	7
Quartil 1	11
Quartil 2	70
Quartil 3	169
Immunosuppressant Drugs
Tacrolimus	26 (72.22%)
Cyclosporine	10 (27.78%)
Mycophenolate	25 (69.44%)
Azathioprine	11 (30.56%)
Prednisone	34 (94.44%)
Clinical features
Donors of the same gender as the recipient	19 (52.78%)
DM	9 (25.00%)
Hypertension	8 (22.22%)
Etiology of Heart Failure
Cardiotoxicity	1 (2.77%)
Non-compaction cardiomyopathy	1 (2.77%)
Chagasic cardiomyopathy	19 (52.77%)
Idiopathic cardiomyopathy	6 (16.66%)
Ischemic cardiomyopathy	3 (8.33%)
Postpartum cardiomyopathy	2 (5.55%)
Restrictive Cardiomyopathy	1 (2.77%)
Valvular cardiomyopathy	2 (5.55%)
Tetralogy of Fallot	1 (2.77%)

Echocardiographic Variable*	Transplanted without rejection (n=36)				Control (n=30)				p-value

	Mean or Median	SD/ QR	QT 1	QT 3	Mean or Median	SD/ QR	QT 1	QT 3
SW (mm)	10.00	10.00	9.00	11.50	8.00	1.00	7.00	8.00	<0.0001^‡
PW (mm)	9.50	9.50	8.00	11.00	7.50	1.00	7.00	8.00	<0.0001^‡
LVDD (mm)	43.69	3.09	-	-	44.70	3.20	-	-	0.2011^†
LVSD (mm)	28.00	28.00	26.50	31.00	28.00	3.00	26.00	29.00	0.5027^‡
EF Teicholz (%)	65.49	5.23	62.53	67.76	66.91	6.35	64.43	70.78	0.0491^‡
LVDV Simpson (mL)	74.99	23.00	60.00	83.00	73.00	28.00	63.00	91.00	0.9790^‡
LVSV Simpson (mL)	26.00	16.00	21.00	37.00	27.00	13.00	20.00	33.00	0.8075^‡
EF Simpson (%)	64.52	6.88	59.78	66.67	62.90	6.74	60.29	67.03	0.7371^†
LV Mass Devereux (g)	148.69	44.51	-	-	108.15	25.88	-	-	<0.0001^†
LV Mass index (g/m²)	90.79	29.89	-	-	59.91	11.53	-	-	<0.0001^†
Relative wall thickness	0.44	0.09	-	-	0.33	0.04	-	-	<0.0001^†
LA Volume (mL)	61.75	29.50	49.75	79.25	34.50	12.00	30.00	42.00	<0.0001^‡
LAi volume (mL/ m²)	38.17	12.90	31.21	44.11	18.98	7.18	16.29	23.47	<0.0001^‡
RA Volume (mL)	35.00	19.00	25.00	44.00	27.50	12.00	22.00	34.00	0.0200^‡
RAi Volume (mL/ m²)	19.91	11.62	15.40	27.02	15.61	7.51	11.55	19.07	0.0014^‡
RV basal (mm)	33.64	5.79	-	-	33.93	3.58	-	-	0.8014^†
RV medial (mm)	29.11	5.41	-	-	26.33	3.96	-	-	0.0226^†
Lateral annulus tricuspid SV (cm/s)	7.40	2.06	-	-	13.37	2.08	-	-	<0.0001^†
TAPSE (mm)	12.51	3.18	-	-	22.97	3.01	-	-	<0.0001^†
RV FAC (%)	42.85	7.51	-	-	44.37	4.55	-	-	0.3159^†

Strain / Myocardial Work*	Transplanted without rejection (n=36)				Control (n=30)				p-value

	Mean or Median	SD/ QR	QT 1	QT 3	Mean or Median	SD/ QR	QT 1	QT 3
LV GLS	11.99	2.740	-	-	20.60	2.15	-	-	<0.0001^†
RV FWLS	16.67	4.33	18.00	13.67	25.50	7.03	30.33	23.30	<0.0001^‡
MWI (mmHg %)	1131.69	469.43	-	-	2005.10	339.10	-	-	<0.0001
GEW (%)	85.43	8.70	-	-	96.30	2.07	-	-	<0.0001
GCW (mmHg %)	1395.91	505.62	-	-	2758.50	3529.20	-	-	<0.0001
GWW (mmHg %)	182.11	143.90	-	-	68.55	52.58	-	-	<0.0001

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[TFN1001] * p-value calculated by Student’s t-test. † p-value calculated by the non-parametric Mann-Whitney test. ‡ p-value calculated by the Chi-square test. QR: Interquartile range; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; BS: body surface; BMI: body mass index; QT: quartile. Note: values expressed as mean and standard deviation, or median and interquartile range/with the intervals of the first and third quartile, or frequency (%)