Abstract
Introduction
Antibody mediated rejection (AMR) is still an important issue in heart transplantation (HT). The standard methods of diagnosis and treatment remain controversial, whereas immunosuppressive therapy is mainly used to prevent cellular rejection.
Purpose
To determine predictors of AMR using the routine investigations in clinical practice.
Methods
During 7 years we conducted a single center study of 181 HT recipients. Patients were divided into 5 groups based on AMR and detected anti-HLA, such as DSA and non-DSA antibodies. Recipients underwent immunology screening and HLA antibodies tests, DSA; 2D-speckle-tracking echocardiography using the Kruskal-Wallis and Wilcoxon signed-rank tests; Spearman correlation, the table of critical values for the Pearson correlation. Kaplan-Meier curves were used to estimate the survival rate. Roc-analysis was used to measure the diagnostic accuracy. Statistical analysis was performed with the STATISTICA 10 (Tibco, USA).
Results
The study demonstrated the lowest survival in patients with anti-HLA antibodies, such as anti-HLA and non-DSA antibodies versus recipients without anti-HLA de novo. Survival in patients with DSA is 40%, and in patients without DSA is 68%. It should be noted that comparing of survival in patients with HLA identified in different post-transplant period showed that patients with HLA-antibodies identified in late post-transplant period had worse survival (50%) than recipients who developed antibodies in the early post-transplant period (75%). On the second stage of the study we conducted 2D-speckle-tracking echocardiography. At first we estimated 2D-STE parameters for the selected groups of patients in the first period of our study, and then during AMR and the late period of the study. AMR effectively reduces the parameters of deformation and mechanics, GLPS LV,%i = −9,94±1,37, RadS LV,% 19,36±3,66, Cir SLV,% −17,83±4,89, ROT APEX°,4,51±1,46, ROT BASE°, −4,75±2,12, ROT MID° 1,94±1,41, TWIST,% 8,90±1,85, RV-FWS,% −15,89±0,89. The possible criteria for diagnosis of AMR include global peak systolic strain, sensitivity (S) 86,2%, specificity (Sp) 90,4%, radial systolic strain, S 75,8%, Sp 84,5% circular systolic strain, S 78,6%, Sp 84,4%; left ventricular twist S 66,7%, Sp 94,2% (p<0,001).
Conclusions
There is a correlation between changes and parameters of 2D-speckle-tracking echocardiography. DSA limits the survival and increases the risk for AMR.
POST-SYSTOLIC STRAIN INDEX MEASURED BY 2D SPECKLE TRACKING ECHOCARDIOGRAPHY PREDICTS CONGESTIVE HEART FAILURE IN VERY ELDERLY HYPERTENSIVE PATIENTS
