title: Echocardiographic indexes of allograft rejection in pediatric cardiac transplant recipients.
abstract: To determine the usefulness of echocardiographic indexes of left ventricular (LV) function as possible predictors of cardiac rejection, 12 transplant recipients (ages 3 to 17 years) underwent a total of 52 serial echocardiographic examinations and cardiac biopsies. The results were compared to those of 12 normal children (ages 2 to 17 years). Biopsies were graded as no rejection (n = 23), mild rejection (cellular infiltrate, n = 13), and moderate rejection (myocyte necrosis, n = 16). LV dimensions, percent shortening fraction, indexed LV mass, and ejection fraction were measured from M-mode and two-dimensional echocardiography. From the mitral valve Doppler tracing, the following measurements were made: isovolumic relaxation time, peak E and peak A velocities, and the fraction of filling under the E and A waves as well as in the first third of diastole. Compared with normal subjects, transplant recipients with no rejection had higher heart rates (95 +/- 15 vs 80 +/- 17 beats/min), longer isovolumic relaxation time (68.8 +/- 11.2 vs 51.5 +/- 13.6 msec), decreased first third area fraction (0.48 +/- 0.10 vs 0.57 +/- 0.10), and similar shortening fraction, LV mass, and peak E and A velocities (p less than 0.03). Compared with transplant recipients with no rejection, patients in whom mild rejection developed also had decreased shortening fraction (31% +/- 10% vs 37% +/- 8%) and decreased peak E velocity (0.68 +/- 0.19 vs 0.88 +/- 0.15 m/s) (p less than 0.03). From mild to moderate rejection, no further changes were noted in any echocardiographic indexes measured.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor 48109-0204.
authors.forename: M A
authors.initials: MA
authors.lastname: Frommelt
authors.forename: A R
authors.initials: AR
authors.lastname: Snider
authors.forename: D C
authors.initials: DC
authors.lastname: Crowley
authors.forename: J N
authors.initials: JN
authors.lastname: Meliones
authors.forename: K P
authors.initials: KP
authors.lastname: Heidelberger
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003971:Diastole; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006084:Graft Rejection; D006339:Heart Rate; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000276:immunology / Q000502:physiology; D006801:Humans; D008297:Male; D016277:Ventricular Function, Left