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Acute allograft rejection (AAR) is the major cause of morbidity and mortality in the first year after heart transplantation (HT). If not treated early, episodes of AAR lead to a poor prognosis. Detection and treatment of AAR at a sub-clinical level is critical. We sought to analyze if deformation parameters could detect a high degree of AAR.Methods: we include 14 consecutive patients transplanted during the last year in our centre. Ten echocardiograms per patient were done the same day of endomyocardial biopsy (EMB). We recorded images of 4 and 2-chamber apical views and short axis views. For the assessment of longitudinal (long S), circunferencial (Circ S) and radial (Rad S) strain curves, we analyzed 16 segments.Results: we analyzed 3024 segments (5% were not interpretable). According to the International Society of Heart and Lung Transplantation criteria, 84 biopsies had grade 0R AAR, 17 had IR, and 8 had 2R. A long S cut-off value of -13.2% was associated with sensitivity of 71%, specificity of 70% and negative predictive value of 96.2% to discriminate a degree of rejection that requires treatment (> 1R). We compared > 1R vs ≤ 1R AAR longitudinal deformation parameters with the next results: Long S (-12.2 ± 2.9 vs -15.4 ±3.8, P= 0.02), long SR (-0.97±0.1 vs -1.18±0.4 p= 0.01). Different cut-off points are shown in the table below.Conclusions: Strain imaging is a reliable tool to discriminate ISHLT rejection grade 2R or higher in heart transplant recipients. Compared with EMB, deformation parameters are easier to repeat, its measure is not invasive and they are less expensive. Therefore, with the application of 2D strain, the number of biopsies could be decreased and be performed only when there is a suspiction of AAR> IR.