Anything but a biopsy: noninvasive monitoring for cardiac allograft rejection.
Endomyocardial biopsy has stood the test of time as a surveillance technique; however, the expense, resources required, invasive nature, and low but definite risks have motivated investigators to pursue less invasive techniques. The search for noninvasive surveillance techniques for cardiac rejection have centered on measurements of cardiac function, intragraft electrical events, peripheral proteomic markers of graft micronecrosis, immune activation, and nonimmune accompaniments of rejection. Although several investigations allude to a reasonable negative predictive value of such monitoring, the specificity of these techniques remains poor. Until well-constructed studies not only define the predictive values of noninvasive techniques but also appropriately evaluate the clinical safety of any such approach, invasive endomyocardial biopsy will remain the gold standard.
Mehra
Mandeep R
MR
Ochsner Cardiomyopathy and Heart Transplantation Center, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA. mmehra@ochsner.org
Uber
Patricia A
PA
Uber
Walter E
WE
Park
Myung H
MH
Scott
Robert L
RL
D001706:Biopsy; D004562:Electrocardiography; D004699:Endocardium / Q000473:pathology*; D006084:Graft Rejection / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity