[Myocardial mass index in the diagnosis of acute rejection of allogeneic heart transplants].
Changes in an index of left ventricular mass were evaluated in the diagnosis of acute cardiac transplant rejection in a prospective study involving 28 transplant patients by comparison with the histology of endomyocardial biopsy. The surface of a ring of left ventricular myocardium obtained from a 2D echocardiographic examination was used as an index of mass. Eighty-three pairs of results--biopsy and index of mass--recorded within a 12 hour interval were obtained between the first day and 10th month of transplantation over a period of 12 consecutive months. Echocardiographic diagnosis of acute rejection was made when the index of myocardial mass increased by over 7 per cent compared with baseline values recorded during the first 3 days of transplantation or during a new period of equilibrium after an episode of rejection. Two groups of patients were identified from the results of biopsy, taken as the reference: in 16 patients with mild or moderate histological signs of rejection the variation of the index of mass was 18.3 +/- 9.1%; endomyocardial biopsy was negative in the 12 other patients and the change in index of mass was -1.5 +/- 5.2% (p less than 0.001). The overall concordance in the 83 successive results was good with a Kappa coefficient of 0.71. The other parameters which have been reported to be useful in diagnosing rejection (relaxation, antegrade diastolic mitral flow, acoustic density of myocardium) present a number of problems in routine practice related either to difficulties with the recording of the data or to its interpretation.(ABSTRACT TRUNCATED AT 250 WORDS)
Laurent
F
F
Service de chirurgie thoracique et cardiovasculaire, CHU Henri-Mondor, Créteil.
Benvenuti
C
C
Mourtada
A
A
Duval
A M
AM
Tavolaro
O
O
Brun
P
P
Rauss
A
A
Loisance
D
D
Cachera
J P
JP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D015150:Echocardiography, Doppler; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014184:Transplantation, Homologous
Intérêt de déterminer la variation d'un indice de masse myocardique dans le diagnostic du rejet aigu d'une greffe cardiaque allogénique.