title: Left ventricular mass increases during cardiac allograft vascular rejection.
abstract: OBJECTIVE
  This study evaluated whether left ventricular mass increases during cellular or vascular (humoral) cardiac allograft rejection.
  
  
  BACKGROUND
  An increase in left ventricular mass during cellular cardiac allograft rejection has been described by other investigators, although controversy has existed over the validity of these findings. Left ventricular mass changes have not been evaluated in the setting of vascular (humoral) cardiac allograft rejection.
  
  
  METHODS
  To determine the effect of allograft rejection on left ventricular mass, we retrospectively reviewed endomyocardial biopsy results and corresponding echocardiograms in 41 cardiac transplant recipients undergoing treatment for allograft rejection. Left ventricular mass was assessed by two-dimensional echocardiography using the method of Schiller. Maintenance immunosuppression included cyclosporine in all patients.
  
  
  RESULTS
  Although significant changes in left ventricular wall thickness, mass and dimensions were not observed in patients experiencing moderate or severe cellular allograft rejection (International Society for Heart and Lung Transplantation grades III and IV, n = 27), marked changes were noted in patients with vascular (humoral) rejection (n = 14). Patients with vascular rejection demonstrated an echocardiographic mean (+/- SEM) increase in left ventricular wall mass (from 109 +/- 17 to 151 +/- 17 g), and left ventricular wall thickness (from 1.3 +/- 0.1 to 1.6 +/- 0.1 cm) during the rejection episode. Additionally, vascular rejection was associated with a trend toward an increase in left ventricular systolic dimension (from 2.6 +/- 0.1 to 3.0 +/- 0.2 cm) and a decrease in left ventricular fractional shortening and increased incidence of hemodynamic compromise with rejection (50% for vascular vs. 11% for cellular rejection).
  
  
  CONCLUSIONS
  Left ventricular mass increases during episodes of vascular (humoral) rejection, but there is no significant change in left ventricular mass during cellular cardiac allograft rejection.
authors.affiliation: Division of Cardiology, University of Utah, Salt Lake City.
authors.forename: E A
authors.initials: EA
authors.lastname: Gill
authors.forename: C
authors.initials: C
authors.lastname: Borrego
authors.forename: B E
authors.initials: BE
authors.lastname: Bray
authors.forename: D G
authors.initials: DG
authors.lastname: Renlund
authors.forename: E H
authors.initials: EH
authors.lastname: Hammond
authors.forename: E M
authors.initials: EM
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies