ORIGINAL INVESTIGATION Two-Dimensional Speckle Tracking Echocardiography in Heart Transplant Patients: Two-Year Follow-Up of Right and Left Ventricular Function Vanessa Mo~ nivas Palomero, M.D.,* Susana Mingo Santos, Ph.D.,* Josebe Goirigolzarri Artaza, M.D.,* Elena Rodriguez Gonzalez, M.D.,* Mar  ıa Alejandra Restrepo C ordoba, M.D.,* Diego Jim enez Sanchez, M.D.,* Betsaida Rivero Arribas, B.Sc.,* In es Garcia Lunar, M.D.,* Cristina D. Mitroi, M.D.,* Ines Sayago Silva, Ph.D.,* Miguel A. Cavero Gibanel, M.D.,* Manuel G omez Bueno, M.D.,† Luis A. Alonso Pulp on, Ph.D.,† and Javier Segovia Cubero, Ph.D.† *Department of Cardiac Imaging, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain; and †Department of Heart Failure, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain Background: Evolution of left and right ventricular (LV and RV) function after heart transplantation (HT) has not been well described. Our objective was to evaluate the evolution of echocardiographic parame- ters of both ventricles along the first 2 years after HT. Methods: We followed 31 HT recipients with serial echocardiograms for up to 2 years. Echocardiograms with AR ≥2R were excluded. We analyzed LV glo- bal longitudinal strain (LV GLS) by speckle tracking in 12 segments in four- and two-chamber views and RV global longitudinal strain (RV GLS) in four-chamber view. Control group included 25 healthy volun- teers. Results: Even though LVEF was preserved, LV GLS was reduced early post-HT (17.7  3.0 in HT vs. 20.7  2.8 in controls, P = 0.02), improving progressively until its complete normalization 2 years after HT (20.0  3.7 vs. 20.7  2.8, P = 0.60). TAPSE was impaired in the early post-HT period and increased progressively (11.9  2.9 mm at baseline vs. 19.0  3.6 mm at 2 years, P < 0.001). RV GLS rose during follow-up as well (17.4  3.5 at baseline vs. 22.6  3.3 at 2 years, P = 0.001), reaching normal values 1 year after HT. Conclusion: In this series of HT recipients with uneventful postoperative course, LV and RV GLS values were significantly reduced early after HT and improved progressively until their complete normalization two and 1 year after HT, respectively. This is the first study to show a full recovery of LV and RV deformation parameters and offers “normal” strain values that, if confirmed in larger studies, could be useful for monitoring the evolution of HT recipients. (Echocardiography 2016;00:1–11) Key words: heart transplantation, acute rejection, speckle tracking, strain Over the past decades, heart transplantation (HT) has become a standard therapy for advanced heart failure. It is well known that sur- gical technique, ischemic time, increased pul- monary vascular resistance, denervation, or immunosuppressive therapy may alter the car- diac graft function. 1,2 To assess graft function of HT patients, echocardiography is a particularly useful tool 3 and two-dimensional speckle tracking echocardiogra- phy (STE) has been recently introduced as an attractive, angle-independent method to measure cardiac mechanical function. This technique has shown ability to detect early changes in HT animal experimental models with acute rejection (AR) episodes. 4,5 Additionally, Kato et al. have recently published a new method to noninvasively exclude AR based on left ventricular (LV) torsion and glo- bal longitudinal strain (GLS) values. 6,7 However, the normal evolution of deformation and conven- tional LV and RV function in early and midterm healthy HT recipients is not well known. Reference LV GLS values in healthy HT patients 1 year after transplantation were defined by Saleh et al., 8 while Pitcher 9 described normal regional and global deformation values 10 years after HT. Both studies demonstrated that even though “healthy” HT recipients without coronary artery disease exhibited normal global systolic function, deformation indices were reduced. Right ventricular (RV) dysfunction is increas- ingly being recognized as a major predictor of symptomatic limitation and long-term outcomes in a variety of disease states. 10–13 A previous study found that, after cardiac surgery with car- diopulmonary bypass (CBP) and complete Address for correspondence and reprint requests: Vanessa Mo~ nivas Palomero, M.D., Manuel de Falla 1., 28222 Majada- honda, Spain. Fax: +34911916652; E-mail: vanessamonivas@gmail.com 1 © 2016, Wiley Periodicals, Inc. DOI: 10.1111/echo.13169 Echocardiography