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Introduction: We have recently shown that presence of reduced right ventricular (RV) fractional shortening identifies pediatric heart transplanted patients (c-Tx) with acute rejection. No data are available on speckle tracking (STE)-derived right ventricular systolic indices in stable c-Tx pediatric patients.Methods: 55 c-Tx patients and 10 healthy volunteers underwent standard 2D examination with analysis of RV-STE (iE33, Philips). Analysis of STE was used to derive right ventricular longitudinal strain (RV-Ls) and tricuspid annular plane longitudinal displacement (T-MAD). Data obtained by STE were compared to 2D and Tissue Doppler indices of RV function, including RV fractional shortening, tricuspid annular plane systolic excursion (TAPSe) and tricuspid TDI systolic peak (Ts'). To evaluate possible progressive impairment of RV function, c-Tx patients were dichotomized according to the time from cardiac transplant.Results: Patients with evidence of rejection, established coronary artery occlusion, EF< 55%, inadequate echocardiographic images and/or with transplant performed less than 4 months before the echocardiogram were excluded. Accordingly data from 43 c-Tx patients were available for analysis. Mean time from heart transplant was 5.8 years. No differences were observed between normals and c-Tx in RV fractional shortening (45% vs 46%; p=ns) suggesting normal chamber RV function in children with c-Tx. However evidence of longitudinal systolic dysfunction could be observed in c-Tx, characterized by reduced TAPSe (12vs20mm) and T-MAD (8.3vs13mm; both p<0.01). In addition a significant reduction was also observed in both the velocity (TDI s': 8.5vs11.8cm/s in normals) and the extent of RV longitudinal systolic contraction (RV-Ls: -16.5vs-33% in normals; both p<0.001). In post-hoc analysis, patients with transplantation performed over 4 years before the examination (n=27), showed a significant reduction in RV fractional shortening as compared to patients with transplant performed within the last 4 years (44vs49%; p<0.05), paired with a mild increase RV-Ls and T-MAD, suggesting a reduction in global chamber function despite a partially compensatory increase in longitudinal RV function.Conclusions: Despite normal global chamber function, pediatric c-Tx patients show a significant impairment in longitudinal RV function characterized by a significant reduction in both traditional (TAPSE, TDIs') and STE parameters (RV-LS and T-MAD). In “older” transplants, a significant reduction in RV systolic function is observed, despite an - inefficient - increase in RV longitudinal function.