title: Does the measurement of left ventricular isovolumic relaxation time allow early prediction of cardiac allograft rejection?
abstract: In order to evaluate the value of isovolumic relaxation time measurement for the diagnosis of moderate acute rejection episodes in cardiac allograft recipients a comparison was made with the histological results from the endomyocardial biopsy. A total of 202 isovolumic relaxation time measurements from 26 patients were compared to the biopsy results. The technique used to record isovolumic relaxation time was dual M-mode echocardiography. In addition a combined phonoechocardiography was used for 54 isovolumic relaxation time measurements from 17 patients. A good correlation was found between these two methods. When the biopsy results were normal the isovolumic relaxation time was 71.4 +/- 15.1 ms. When moderate acute rejection episodes were present isovolumic relaxation time decreased to 50.2 +/- 21.2 ms (p < 0.001). In spite of the close correlation detected at group level, there was a large variability of the measurements without accompanying changes in the biopsy specimen. At the same time a significant overlap was found between the measurements taken during rejection and non-rejection periods making it impossible to use these methods for clinical decision making. We conclude that isovolumic relaxation time measured with these methods is not a sufficiently sensitive parameter for the diagnosis of moderate acute rejection episodes in the individual patient, and in our experience, it is not a substitute for endomyocardial biopsy and can not be applied for clinical decision making.
authors.affiliation: Department of Echocardiography, Academic Hospital Dijkzigt, Erasmus University Rotterdam, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Forster
authors.forename: J
authors.initials: J
authors.lastname: McGhie
authors.forename: H
authors.initials: H
authors.lastname: Rijsterborgh
authors.forename: K
authors.initials: K
authors.lastname: Meeter
authors.forename: A
authors.initials: A
authors.lastname: Balk
authors.forename: C
authors.initials: C
authors.lastname: Essed
authors.forename: J
authors.initials: J
authors.lastname: Roelandt
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003971:Diastole / Q000502:physiology; D004562:Electrocardiography / Q000295:instrumentation; D004699:Endocardium / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D012849:Sinoatrial Node / Q000503:physiopathology; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology*