title: Evaluation of myocardial performance index to predict mild rejection in cardiac transplantation.
abstract: BACKGROUND
  Early diagnosis of heart transplant rejection is mandatory, since even mild rejection can rapidly progress to more severe rejection. Noninvasive diagnosis of heart transplant rejection still remains a challenge.
  
  
  OBJECTIVE
  The purpose of the study was to determine a possible association between myocardial performance index (MPI) and biopsy score of the heart transplant.
  
  
  METHODS
  This is a retrospective cohort analysis of 99 complete Doppler echocardiographic studies from 24 consecutive patients (23 men) performed within 24 h of endomyocardial biopsy. Mean age of the cohort was 50 +/- 9 years and mean time from transplantation was 19 +/- 21 months (1-81). All patients were in sinus rhythm. Myocardial performance index was calculated as the ratio of isovolumic contraction time plus isovolumic relaxation time divided by ejection time. Left ventricular dimensions, left ventricular mass, ejection fraction, and a number of Doppler indices (E-point velocity, A-point velocity, deceleration time, and deceleration slope) were also measured. The International Society for Heart and Lung Transplantation (ISHLT) grading system was used for the classification of endomyocardial biopsies.
  
  
  RESULTS
  Myocardial performance index was significantly prolonged (0.60 +/- 0.13, 0.68 +/- 0.08, 0.75 +/- 0.20, in biopsy scores 0, IA, and IB, respectively; p<0.001). Isovolumic contraction time was significantly prolonged; isovolumic relaxation time was not significantly changed. Ejection time and deceleration time were significantly shortened. Multivariate stepwise regression analysis revealed that MPI and deceleration time were the only independent predictors of biopsy score (r=0.48, F=10.53, p<0.0001).
  
  
  CONCLUSIONS
  Myocardial performance index seems to be a useful adjunct in the follow-up of cardiac transplant patients. These preliminary data suggest that a larger study may be indicated to clarify the relevance of myocardial performance index.
authors.affiliation: Department of Clinical Therapeutics, School of Medicine, University of Athens, Alexandra Hospital, Athens, Greece. toumanidis@flashmail.com
authors.forename: Savvas T
authors.initials: ST
authors.lastname: Toumanidis
authors.forename: Electra S
authors.initials: ES
authors.lastname: Papadopoulou
authors.forename: Nikolaos S
authors.initials: NS
authors.lastname: Saridakis
authors.forename: Anna T
authors.initials: AT
authors.lastname: Kalantaridou
authors.forename: Emmanuel V
authors.initials: EV
authors.lastname: Agapitos
authors.forename: John N
authors.initials: JN
authors.lastname: Nanas
authors.forename: Stamatios F
authors.initials: SF
authors.lastname: Stamatelopoulos
mesh_terms: D000328:Adult; D001706:Biopsy; D015150:Echocardiography, Doppler; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000276:immunology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000276:immunology / Q000502:physiology*; D009206:Myocardium / Q000276:immunology / Q000473:pathology*; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D013997:Time Factors