Ahmed Elkaryoni1, Ahmed M Altibi2,3, Muhammad Shahzeb Khan4, Osama Okasha1, Karim Ellakany5, Adil Hassan6, Annapoorna Singh1, Raed Qarajeh1, Shrushti Mehta1, Navin C Nanda7. 1. Division of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA. 2. Division of Internal Medicine, Henry Ford Allegiance Health, Detroit, MI, USA. 3. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. 4. Division of Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA. 5. Division of Cardiovascular Disease, University of Alexandria School of medicine, Alexandria, Egypt. 6. Divison of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 7. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract
BACKGROUND: In orthotopic heart transplant recipients, surveillance with endomyocardial biopsy is crucial to detect acute cellular rejection (ACR) early. ACR is a common and serious complication of transplantation with substantial morbidity and mortality. Speckle tracking echocardiography with global longitudinal strain (GLS) assessment of the left ventricle has emerged as a possible noninvasive screening modality. We have conducted a systematic literature review and meta-analysis to evaluate the role of GLS in diagnosing ACR. METHODS: The following databases were queried: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Embase. We compiled all articles evaluating changes in GLS in comparison to endomyocardial biopsy in ACR dated prior to September 2019. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled by using a random effects model. In order to determine the risk of bias, we used the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: Twelve studies met inclusion criteria of which ten were chosen. These studies encompassed 511 patients and 1267 endomyocardial biopsies. There was a significant difference in GLS between patients who did and did not have ACR proven by biopsy (WMD = 2.18; 95% CI: 1.57-2.78, P = <.001; I2 = 76%). The overall sensitivity for GLS in detecting ACR was 78% (CI: 63%-90%, P = .123; I2 = 52.2%) while the overall specificity was 68% (CI: 50%-83%, P = <.001; I2 = 88.3%). CONCLUSION: Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography is useful in detecting ACR and could potentially reduce the burden of frequent endomyocardial biopsies in heart transplant recipients.
BACKGROUND: In orthotopic heart transplant recipients, surveillance with endomyocardial biopsy is crucial to detect acute cellular rejection (ACR) early. ACR is a common and serious complication of transplantation with substantial morbidity and mortality. Speckle tracking echocardiography with global longitudinal strain (GLS) assessment of the left ventricle has emerged as a possible noninvasive screening modality. We have conducted a systematic literature review and meta-analysis to evaluate the role of GLS in diagnosing ACR. METHODS: The following databases were queried: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Embase. We compiled all articles evaluating changes in GLS in comparison to endomyocardial biopsy in ACR dated prior to September 2019. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled by using a random effects model. In order to determine the risk of bias, we used the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: Twelve studies met inclusion criteria of which ten were chosen. These studies encompassed 511 patients and 1267 endomyocardial biopsies. There was a significant difference in GLS between patients who did and did not have ACR proven by biopsy (WMD = 2.18; 95% CI: 1.57-2.78, P = <.001; I2 = 76%). The overall sensitivity for GLS in detecting ACR was 78% (CI: 63%-90%, P = .123; I2 = 52.2%) while the overall specificity was 68% (CI: 50%-83%, P = <.001; I2 = 88.3%). CONCLUSION: Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography is useful in detecting ACR and could potentially reduce the burden of frequent endomyocardial biopsies in heart transplant recipients.
Authors: Sara Rodríguez-Diego; Martín Ruiz-Ortiz; Mónica Delgado-Ortega; Jiwon Kim; Jonathan W Weinsaft; José J Sánchez-Fernández; Rosa Ortega-Salas; Lucía Carnero-Montoro; Francisco Carrasco-Ávalos; José López-Aguilera; Amador López-Granados; José M Arizón Del Prado; Elías Romo-Peñas; Laura Pardo-González; Francisco J Hidalgo-Lesmes; Manuel Pan Álvarez-Ossorio; Dolores Mesa-Rubio Journal: J Clin Med Date: 2022-08-25 Impact factor: 4.964