[Echocardiography in the early diagnosis of acute rejection in patients with heart transplant].
The aim of our study was to assess the sensibility and specificity of Doppler echocardiographic evaluation of left ventricular diastolic function during acute cardiac rejection. We studied 34 patients who had undergone a recent heart transplant and compared the echocardiographic results with the histologic findings. We considered the following parameters of left ventricular filling: early peak of mitral flow velocity; pressure half-time (PHT); isovolumic relaxation time (IVRT). We divided the patients into two groups according to the histologic findings: Group I (25 patients who had at least 1 episode of mild-moderate rejection), Group II (6 patients without documented rejection after at least three consecutive biopsies). Three patients with clinically evident rejection were excluded from the analysis. In Group I cardiac rejection was associated with a statistically significant decrease in IVRT (p < 0.0005), without significant changes in heart rate and in the early peak of mitral flow velocity. In Group II Doppler parameters remained unchanged. These variations were not associated with changes in echocardiographic morphologic parameters and in parameters of ventricular systolic function. IVRT and PHT returned to normal values after adequate immunosuppressive treatment. Considering variations of IVRT and PHT of at least 20%, we obtained a sensibility of 88% for isolated variations of PHT and a specificity of 93% for consensual variations of PHT and IVRT. Therefore, the assessment of the left ventricular diastolic function by Doppler echocardiography represents a safe and non-invasive method for an early detection of acute cardiac rejection.
Nicosia
A
A
Istituto di Cardiologia, Università degli Studi, Catania.
Castania
G
G
Greco
G
G
Tamburino
C
C
Gentile
M
M
Bartoloni
A
A
Bartoloni
G
G
Italia
F
F
Calvi
V
V
Abbate
M
M
D000208:Acute Disease; D000328:Adult; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis*; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013997:Time Factors
L'ecocardiografia nella diagnosi precoce di rigetto acuto nei pazienti sottoposti a trapianto cardiaco.