High Intra-Patient Variability of Echocardiographic Parameters is Associated with Heart Transplantation Outcomes: Report of a Real-World Experience

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S286
• Main Authors: Peled, Y., Feinberg, M., Lavee, J., Vatury, O., Hay, I., Zekry, S.Ben, Shlomo, N., Koperstein, R., Schwammenthal, E.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.716

Although echocardiography is not recommended as a modality for rejection monitoring, serial echocardiography is routinely performed in patients following heart transplantation (HT). We sought to investigate the intra-patient fluctuations of structural and hemodynamic echocardiographic indexes and explore whether variability (relative changes), rather than absolute values, is associated with HT outcomes.
Between 2004-2017 we reviewed 723 echocardiographic examinations of 107 HT patients, at 0-3 months after HT. The following indexes were studied: interventricular septal (IVS) and posterior wall (PW) thickness, ejection fraction (EF), mitral valve deceleration time (DT), peak velocity flow in early (E) and late diastole (A) and their ratio (E/A), lateral and septal annular velocity (e’), and systolic pulmonary pressure (SPAP). Coefficients of variation (CV) were calculated for each parameter as the percent ratio of its standard deviation and its mean value. Endpoints, assessed from 3 months post HT, included any-treated rejection (ATR), all-cause mortality and cardiac allograft vasculopathy.
CV was highest for E/A ratio (25±17%) and lowest for EF (6±4%). ATR was significantly associated with a higher CV of EF, DT, E, E/A, SPAP, e’ (p<0.05, all) and mortality was significantly associated with a higher CV of E/A and A (p<0.05). Multivariate analyses adjusted for age and gender showed that high CV was independently associated with increased risk of ATR and mortality (Table).
High intra-patient (study-to-study) variability in echocardiographic indexes of left ventricular wall thickness, left ventricular filling and pulmonary artery pressure is associated with a higher rate of clinically significant rejections and mortality. The degree of variation of these parameters, rather than their absolute value, might be more useful during serial follow-up to identify patients at risk for unfavorable outcomes.