Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

Background: Despite the risk for complications, allograft surveillance after orthotopic heart transplantation (OHT) is performed by cardiac catheterization and biopsies. We investigated the diagnostic and prognostic value of a TDI-derived systolic wall motion analysis of the posterobasal wall of the left ventricle (Sm) as a screening modality in OHT aftercare. Methods: We examined data of 210 eligible patients who underwent OHT between 2010 and 2020. Forty-four patients who had died within the initial hospital stay were excluded. For 166 patients, baseline and follow-up data were analyzed. The mean age at OHT was 46.2 (& PLUSMN;11.4) years; 76.5% were male. Results: Within the observational period, 22 (13.3%) patients died. In total, 170 episodes of acute cellular or humoral rejections occurred (84 ISHLT1R; 13 ISHLT2R; 8 ISHLT3R; 65 AMR), and 29 catheterizations revealed cardiac allograft vasculopathy (5 CAV1; 4 CAV2; 20 CAV3). Individual Sm radial/longitudinal remained stable within the follow-up period (11.5 & PLUSMN; 2.2 cm/s; 10.9 & PLUSMN; 2.1 cm/s). Patients with acute rejections and CAV3 showed significant Sm radial/longitudinal reductions (AMR1: 1.6 & PLUSMN; 1.9 cm/s, confidence interval (CI) 0.77-0.243, p < 0.001; 1.8 & PLUSMN; 2.0 cm/s, CI 0.92-0.267, p < 0.001. ISHLT1R: 1.7 & PLUSMN; 1.8 cm/s, CI 1.32-2.08, p < 0.001; 2.0 & PLUSMN; 1.6 cm/s, CI 1.66-2.34, p < 0.001. CAV3: 1.3 & PLUSMN; 2.5 cm/s, CI 0.23-2.43, p < 0.017; 1.4 & PLUSMN; 2.8 cm/s, CI 0.21-2.66, p < 0.021). Lower Sm was associated with a threefold increase in all-cause mortality (hazard ratio (HR) 3.24, CI 1.2-8.76, p = 0.020; HR 2.92, CI 1.19-7.18, p = 0.019). Overall, Sm-triggered surveillance led to 0.75 invasive diagnostics per patient post-OHT year. Conclusions: Sm remained stable in the post-OHT course. Reductions indicated ISHLT1R, AMR1 and CAV3 and were associated with higher all-cause mortality. Sm-triggered surveillance may be referred to as a safe, high-yield screening modality in OHT aftercare.

Automated summary

This study investigated the diagnostic and prognostic value of using TDI-derived wall motion analysis as a screening modality in OHT aftercare. The results showed that Sm remained stable during the follow-up period, but reductions were associated with acute rejections and cardiac allograft vasculopathy. Lower Sm was linked to a higher all-cause mortality rate.