Non-invasive Myocardial Strain Imaging to Evaluate Graft Failure in Cardiac Xenotransplantation.
10.4285/jkstn.2017.31.1.25
- Author:
Hyun Suk YANG
1
;
Hyun Keun CHEE
;
Jun Seok KIM
;
Wan Seop KIM
;
Jung Hwan PARK
;
Ki Cheul SHIN
;
Kyoung Sik PARK
;
Seon Won LEE
;
Ka Hee CHO
;
Wan Je PARK
;
Keon Bong OH
;
Curie AHN
;
Ik Jin YUN
Author Information
1. Department of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Heterologous transplantation;
Heart transplantation;
Echocardiography;
Histopathology
- MeSH:
Biopsy;
Echocardiography;
Heart;
Heart Transplantation;
Heterografts;
Humans;
Macaca fascicularis;
Methods;
Pathology;
Stroke Volume;
Transplantation, Heterologous*;
Transplants*;
Ultrasonography;
Wound Healing
- From:The Journal of the Korean Society for Transplantation
2017;31(1):25-33
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.
