title: Acute rejection after heart transplantation: noninvasive echocardiographic evaluation.
abstract: OBJECTIVE
  The purpose of this study was to assess the reliability of echocardiography in the noninvasive diagnosis of acute rejection in heart transplant recipients.
  
  
  BACKGROUND
  Although echocardiographic results seem to correlate well with allograft rejection, published data are limited and contradictory.
  
  
  METHODS
  In 130 transplant recipients, 1,400 serial echocardiograms were recorded within 24 h of endomyocardial biopsy. Increased wall thickness, myocardial echogenicity, pericardial effusion, shorter pressure half-time, isovolumetric relaxation time and a decrease in left ventricular ejection fraction were considered markers of rejection.
  
  
  RESULTS
  The distribution of echocardiographic markers revealed highly significant differences between bioptically graded moderate, mild and no rejection and between untreated and treated rejection episodes (both chi-square test, p < 0.0001). Specificity was 98.6% for two markers, but sensitivity was good (80%) for only moderate rejection because of the large number of false negatives in untreated patients with mild rejection. In untreated patients, there was a highly significant difference in the number of echocardiographic criteria between a benign and nonbenign outcome (chi-square test, p < 0.0001). In treated patients, the significant difference in the variation in echocardiographic criteria between favorable and unfavorable responses after 1 week was more pronounced after 2 weeks (t test, p < 0.01 vs. < 0.001). Diastolic indexes and pericardial effusion at 2 weeks seemed to be predictive of therapeutic response.
  
  
  CONCLUSIONS
  Poor sensitivity to mild rejection indicates that serial echocardiography cannot supplant endomyocardial biopsy in the early diagnosis of acute rejection, but it seems to be a reliable noninvasive means of identifying acute rejection requiring intensified immunosuppressive therapy and of evaluating outcome.
authors.affiliation: Department of Cardiology, Centro A. De Gasperis, Ospedale Niguarda Ca Granda, Milan, Italy.
authors.forename: G R
authors.initials: GR
authors.lastname: Ciliberto
authors.forename: M
authors.initials: M
authors.lastname: Mascarello
authors.forename: E
authors.initials: E
authors.lastname: Gronda
authors.forename: E
authors.initials: E
authors.lastname: Bonacina
authors.forename: M C
authors.initials: MC
authors.lastname: Anjos
authors.forename: G
authors.initials: G
authors.lastname: Danzi
authors.forename: P
authors.initials: P
authors.lastname: Colombo
authors.forename: M
authors.initials: M
authors.lastname: Frigerio
authors.forename: A
authors.initials: A
authors.lastname: Alberti
authors.forename: C
authors.initials: C
authors.lastname: De Vita
mesh_terms: D000208:Acute Disease; D000328:Adult; D004452:Echocardiography; D004699:Endocardium / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity