title: Noninvasive markers for acute heart transplant rejection in children with the use of automatic border detection.
abstract: A noninvasive method to detect heart transplant rejection would allow for increased monitoring at reduced risk. Automatic border detection is a new method to assess diastolic abnormalities. The purpose of this study was to determine whether automatic border detection of left ventricular filling detects rejection in children. Nineteen episodes of biopsy-proven rejection in 10 children were retrospectively reviewed. Echocardiograms during rejection were compared with those before rejection and during recovery. Automatic border detection indices were percentage of total left ventricular filling as a result of rapid filling, diastasis, and atrial contraction. The percentage of total ventricular filling during diastasis increased significantly during rejection (10% +/- 6% versus 15% +/- 8%, p = 0.02), and the percentage of filling during the rapid filling phase decreased during rejection (82% +/- 8% versus 77% +/- 11%, p = 0.08). These changes were even more marked for the most severe episodes of rejection. These changes resolved at recovery. Automatic border detection of left ventricular filling patterns are altered during cardiac rejection in children. Filling during diastasis increases significantly, and filling during the rapid filling phase decreases. A prospective analysis is needed to determine whether these changes in filling can obviate the need for cardiac biopsy.
authors.affiliation: Children's Heart Association Noninvasive Cardiac Imaging and Hemodynamic Research Laboratory, Division of Cardiology, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Kimball
authors.forename: D C
authors.initials: DC
authors.lastname: Semler
authors.forename: S A
authors.initials: SA
authors.lastname: Witt
authors.forename: P R
authors.initials: PR
authors.lastname: Khoury
authors.forename: S R
authors.initials: SR
authors.lastname: Daniels
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003971:Diastole; D004452:Echocardiography; D004699:Endocardium / Q000000981:diagnostic imaging; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000502:physiology; D006801:Humans; D007089:Image Enhancement; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D016277:Ventricular Function, Left