Endocardial infiltrates in the transplanted heart: clinical significance emerging from the analysis of 5026 endomyocardial biopsy specimens.
To further elucidate the significance of endocardial infiltrates in heart transplant patients, the presence, frequency, and type of endocardial infiltrates were evaluated in 5026 endomyocardial biopsy specimens obtained from 200 heart transplant patients 0 to 75 months after heart transplantation. The relationship of endocardial infiltrates to immunologic, clinical, and demographic variables was then explored. Endocardial infiltrates were detected in 557 endomyocardial biopsy specimens (11%) from 117 heart transplant patients (58%) at 6.3 +/- 9.4 months (mean +/- SD; range, 0 to 49 months) after heart transplantation. Heart transplant patients with endocardial infiltrates were younger (p = 0.03), had a greater incidence of idiopathic dilated cardiomyopathy before heart transplantation (p = 0.05), and included a greater percentage of females (p < 0.05). Both total and treated rejection rates were significantly higher in patients with endocardial infiltrates versus those without endocardial infiltrates (p = 0.0001). Rejection on the subsequent endomyocardial biopsies was more often present in endocardial biopsy specimens with endocardial infiltrates than in those without endocardial infiltrates, both in the presence (37% versus 24%; p < 0.001) and absence (33% versus 19%; p < 0.0001) of concomitant findings of rejection. No association was identified between endocardial infiltrates and posttransplantation lymphoproliferative disorder, cytomegalovirus infection, Epstein-Barr virus infection, or cardiac allograft vasculopathy. Multivariate regression analysis confirmed that the occurrence of endocardial infiltrates is associated with rejection when adjustment is made for patient's age, gender, heart disease before transplantation, follow-up time, and number of endomyocardial biopsies after heart transplantation (p = 0.0001).


CONCLUSIONS
(1) Endocardial infiltrates may occur with or without associated endomyocardial biopsy findings of rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
Costanzo-Nordin
M R
MR
Department of Medicine, Loyola University Chicago, Maywood, Ill. 60153.
Winters
G L
GL
Fisher
S G
SG
O'Sullivan
J
J
Heroux
A L
AL
Kao
W
W
Mullen
G M
GM
Johnson
M R
MR
D001706:Biopsy; D002641:Chicago / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000473:pathology; D004699:Endocardium / Q000473:pathology*; D005260:Female; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000473:pathology; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology; D016027:Heart Transplantation / Q000473:pathology*; D006566:Herpesviridae Infections / Q000453:epidemiology / Q000473:pathology; D004854:Herpesvirus 4, Human; D006801:Humans; D015994:Incidence; D007963:Leukocytes, Mononuclear / Q000473:pathology*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000453:epidemiology / Q000473:pathology