ABC | Volume 114, Nº4, April 2020

Original Article Carrion et al. Right ventricular dysfunction and heart transplant Arq Bras Cardiol. 2020; 114(4):638-644 Figure 1 – Feasibility of strain evaluation by speckle-tracking analysis. 2015 – 2016 20 Heart Transplantation Patients 1 patient died before the first biopsy was performed (Hyperacute Rejection) 19 Heart Transplantation Patients followed until July-2017 257 cardiac biopsies and echocardiographies 87 missing views and/or unsuitable images for speckle tracking analysis 170 cardiac biopsies and echocardiographies were included Figure 2 – Two-dimensional speckle tracking imaging for right ventricular analysis in a heart transplant recipient at the time of biopsy-proven 2R rejection (Panel 2A) and the same patient at the time of biopsy without rejection (Panel 2B). Curves represent longitudinal strain curves and the white dot represents peak-systolic strain, which were used to measure right ventricular systolic function. analyzed in this study, 15 biopsies from 12 HTx recipients showed 2R rejection, and 155 biopsies showed either no evidence of cellular rejection or 1R rejection (n = 130 and n = 25, respectively). Heart Structure and Function Compared to exams from patients without rejection or 1R rejection, echocardiograms from corresponding biopsies with 2R rejection episodes revealed greater LV posterior wall thickness, which did not reflect in an increase in LV mass or relative wall thickness. In exams frompatients with 2R rejection, measures of diastolic function showed an increase in the medial and lateral E/e’ ratio and the E/A ratio (Table 2). LV systolic function did not differ between groups when evaluated by the traditional method (LVEF) or by LV GLS (−20.2 ± 3.3% in the 0R/1R group vs. −19.5 ± 3.3% in the 2R group, p = 0.351). On the other hand, RV systolic function was reduced in the 2R group, in comparison with the other group, when evaluated by TAPSE, S wave and RV FAC. Additionally, RV GLS (−22.97 ± 4.4% in the 0R/1R group vs. −20.6 ± 4.9% in the 2R group, p = 0.038) was reduced in the 2R group, in comparison with the 0R/1R group (Figure 3). 640