Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation

Annika Ingvarsson; Anna Werther Evaldsson; Johan Waktare; Johan Nilsson; Gustav J Smith; Martin Stagmo; Anders Roijer; Göran Rådegran; Carl J Meurling

doi:10.1016/j.echo.2017.11.003

Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation

J Am Soc Echocardiogr. 2018 Mar;31(3):349-360. doi: 10.1016/j.echo.2017.11.003. Epub 2017 Dec 21.

Authors

Annika Ingvarsson¹, Anna Werther Evaldsson², Johan Waktare³, Johan Nilsson⁴, Gustav J Smith², Martin Stagmo², Anders Roijer², Göran Rådegran², Carl J Meurling²

Affiliations

¹ Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden. Electronic address: annika.ingvarsson@med.lu.se.
² Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden.
³ Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
⁴ Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Lund, Sweden.

PMID: 29275986
DOI: 10.1016/j.echo.2017.11.003

Abstract

Background: Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients.

Methods: The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects.

Results: Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62 ± 7%, P < .01) and global longitudinal strain (-16.5 ± 3.3%, P < .0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P < .0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15 ± 4 mm [P < .0001], RV systolic tissue Doppler velocity 10 ± 6 cm/sec [P < .0001], fractional area change 40 ± 8% [P < .0001], and RV free wall strain -16.9 ± 4.2% [P < .0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection.

Conclusion: The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.

Keywords: Allograft; Heart transplantation; Speckle-tracking; Strain; Two-dimensional echocardiography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Cardiac Volume / physiology*
Echocardiography, Doppler / methods*
Female
Follow-Up Studies
Heart Transplantation*
Heart Ventricles / diagnostic imaging*
Humans
Male
Middle Aged
Prospective Studies
Reference Values
Stroke Volume / physiology*
Transplant Recipients*
Ventricular Function, Left / physiology*
Young Adult