AUTHOR=Otto Maria Estefânia Bosco , Martins Aline Maria Araújo , Campos Dall’Orto Aline de Oliveira Martins , Leite Simone Ferreira , de Queiroz Mauricio Filho Marco Antonio Freitas , Martins Natalia Taveira , de Araújo Samuel Rabelo , Almeida Soraya Vasconcelos , Paiva Mariana Ubaldo Barbosa , Atik Fernando Antibas 

TITLE=Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.841698

DOI=10.3389/fcvm.2022.841698

ISSN=2297-055X

ABSTRACT=Background: Echocardiographic markers associated with asymptomatic acute cellular rejection (ACR) in patients with orthotopic heart transplant (HT) are still under investigation. The aim of our study was to determine clinical and myocardial strain imaging (MSI) variables evaluated by echocardiography associated with ACR at the first year of heart transplant, displaying important methodological framework in the first six months, and analyze an exclusive population with Chagas’ disease as the cause for HT.
Methods: We prospectively studied 67 patients with less than one-year of HT, 36 patients without ACR (41% men, age 49±12 years, 52% Chagas disease as cause of heart failure) and 31 with ACR (59% men, age 55±8 years, 74% Chagas disease as cause of heart failure). Conventional echocardiographic measurements and MSI by Global Longitudinal Strain (GLS) from left (LV) and right ventricles (RV) and myocardial work (MW) from the LV, were obtained. Clinical variables such as presence of diabetes, hypertension and immunosuppressor drugs were compared. 
Results:  HT patients with ACR were older, using more cyclosporine for immunosuppressor. HT with ACR had increased relative wall thickness and LV mass index and similar LV and RV GLS. Nevertheless, MW analysis observed increased global work efficiency (GWE) in ACR. Multivariate analysis observed older age, cyclosporine use, LV mass index and GWE independent predictors for rejection. A framework analyzes of patients with less than 6 months of HT was performed and observed similar MSI in both groups with a trend for increased GWE in patients with ACR. A unique group of only Chagas patients as primary cause of HT was analyzed, and similar MSI results for LV, RV GLS and MW was observe for both ACR and no rejection, besides survival in two years was similar between groups.
Conclusions: MSI is not able to detect changes in HT with asymptomatic ACR at the first six months. Conversely, GWE  is increased in PACR . LV remodeling however is more evident in ACR. MSI in HT due to Chagas Cardiomyopathy is similar to other primary causes for transplant, and rejection at the first year does not increase mortality at two years of follow up.