An improved echocardiographic rejection-surveillance strategy following pediatric heart transplantation.
BACKGROUND
The unique demands of cardiac transplantation in infancy have led to non-invasive rejection-surveillance strategies. ECHO-A is a multiparametric, two-dimensionally guided, M-mode analysis algorithm that assigns an empirically derived score for deviations of recipient parameters to age-adjusted, population-based normal values. A cumulative ECHO-A score > or =4 is highly predictive of endomyocardial biopsy Grade > or =3 and of cellular rejection.


METHODS
This study determined whether modifying ECHO-A to score for deviations of recipient parameters from the recipient's baseline would improve the predictive power of ECHO-A. We reanalyzed 701 consecutive echocardiograms of 18 pediatric cardiac transplant recipients (median age at transplantation, 142 days) and based scoring on significant (Z score > or =1) deviation from the patients' baseline means (ECHO-B).


RESULTS
Eight episodes of treated rejection occurred during the first year after transplantation (median, 1.4 years). Approximately 10% (72) of the analyses had ECHO-A scores > or =4 that were not associated with treated rejection and were considered false positives. We identified parameters that contributed to the false-positive evaluations and calculated patient-specific baseline mean +/- standard deviation. The ECHO-B, in comparison with ECHO-A, decreased the number of false positives from 72 to 10, increased specificity from 90% to 99%, and increased the positive predictive value about 4-fold (10% to 44%). With treated rejection episodes, ECHO-B increased ECHO-A scores in 7 of 8 recipients and increased the mean score from 6 to 8.


CONCLUSIONS
analysis algorithm based on change from baseline improved the positive predictive power without reducing the negative predictive value of multiparametric quantitative analyses of echocardiograms following pediatric heart transplantation.
Putzer
G J
GJ
University of South Florida at All Children's Hospital, St. Petersburg, Florida, USA.
Cooper
D
D
Keehn
C
C
Asante-Korang
A
A
Boucek
M M
MM
Boucek
R J
RJ
D000367:Age Factors; D000465:Algorithms; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D002306:Cardiac Volume / Q000502:physiology; D016009:Chi-Square Distribution; D016572:Cyclosporine / Q000627:therapeutic use; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005189:False Positive Reactions; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000627:therapeutic use; D009206:Myocardium / Q000473:pathology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000502:physiology
D007166:Immunosuppressive Agents; D008776:Methylprednisolone Hemisuccinate; D016572:Cyclosporine; D001379:Azathioprine