Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation. We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 – 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09–1.31) vs 0.05 ng/mL (0.01–0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68–0.92), 0.89 (0.81–0.93) and 0.79 (0.66–0.92), respectively. Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.

中文翻译：

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斑点追踪超声心动图和生物标志物在检测心脏移植后急性细胞排斥反应中的有用性

急性细胞排斥反应 (ACR) 是心脏移植后的主要并发症。心内膜心肌活检 (EMB) 仍然是其诊断的金标准，但它存在相关并发症。我们评估了斑点跟踪超声心动图 (STE) 和生物标志物在心脏移植后检测 ACR 的有用性。我们前瞻性研究了 60 名左右心室收缩功能正常的移植患者，这些患者在移植后 6 个月接受了 EMB 监测。60 名年龄和性别匹配的健康个体构成对照组。常规超声心动图参数，左心室整体纵向、径向和周向应变（分别为 LV-GLS、LV-GRS 和 LV-GCS），在手术前分析左心室收缩扭曲 (LV-twist) 和右心室游离壁纵向应变 (RV-FWLS)。同时，我们还测量了生物标志物。在 60 名研究患者中，17 名 (28%) 有严重 ACR（≥ 2R 级），43 名（72%）没有显着 ACR（0 – 1R 级）。ACR 程度≥ 2 R 的移植患者的 LV-GLS、LV-twist 和 RV-FWLS 的绝对值低于没有 ACR 的患者（12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° 与 17.1° ± 3.2°，p=0.048；16.6% ± 2.9% 与 21.4%± 3.2%，p < 0.001；分别），而在 LV-GRS 或 LV-GCS 之间没有观察到差异。除了 LV-twist 外，所有这些参数在没有 ACR 的移植组中都低于非移植对照组。有显着 ACR 的患者的心肌肌钙蛋白 I 水平显着高于无显着 ACR 的患者 [0.19 ng/mL (0.09–1.31) vs 0.05 ng/mL (0.01–0.18), p=0.007]。肌钙蛋白与 LV-GLS、RV-FWLS 和 LV-Twist 的组合检测 ACR 的曲线下面积分别为 0.80 (0.68-0.92)、0.89 (0.81-0.93) 和 0.79 (0.66-0.92)。与对照个体相比，心脏移植患者的左心室动力学发生了改变。肌钙蛋白与应变参数的组合检测 ACR 的准确性高于孤立变量，这种关联可能会选择 ACR 风险较高的患者，这些患者将在心脏移植后的第一年从 EMB 手术中受益。p=0.007]。肌钙蛋白与 LV-GLS、RV-FWLS 和 LV-Twist 的组合检测 ACR 的曲线下面积分别为 0.80 (0.68-0.92)、0.89 (0.81-0.93) 和 0.79 (0.66-0.92)。与对照个体相比，心脏移植患者的左心室动力学发生了改变。肌钙蛋白与应变参数的组合检测 ACR 的准确性高于孤立变量，这种关联可能会选择 ACR 风险较高的患者，这些患者将在心脏移植后的第一年从 EMB 手术中受益。p=0.007]。肌钙蛋白与 LV-GLS、RV-FWLS 和 LV-Twist 的组合检测 ACR 的曲线下面积分别为 0.80 (0.68-0.92)、0.89 (0.81-0.93) 和 0.79 (0.66-0.92)。与对照个体相比，心脏移植患者的左心室动力学发生了改变。肌钙蛋白与应变参数的组合检测 ACR 的准确性高于孤立变量，这种关联可能会选择 ACR 风险较高的患者，这些患者将在心脏移植后的第一年从 EMB 手术中受益。与对照个体相比，心脏移植患者的左心室动力学发生了改变。肌钙蛋白与应变参数的组合检测 ACR 的准确性高于孤立变量，这种关联可能会选择 ACR 风险较高的患者，这些患者将在心脏移植后的第一年从 EMB 手术中受益。与对照个体相比，心脏移植患者的左心室动力学发生了改变。肌钙蛋白与应变参数的组合检测 ACR 的准确性高于孤立变量，这种关联可能会选择 ACR 风险较高的患者，这些患者将在心脏移植后的第一年从 EMB 手术中受益。