Non-invasive evaluation of orthotopic heart transplant rejection by echocardiography.
BACKGROUND
Heart transplant recipients require frequent myocardial biopsies to screen for acute rejection. The purpose of this study was to identify demographic and echocardiographic factors associated with transplant rejection and develop a predictive model, which may reduce the number of cardiac biopsies.


METHODS
From January 1998 to December 2001, we performed 406 echocardiographic studies on 264 heart transplant patients who had biopsies performed on the same day. Two-dimensional, pulsed and tissue Doppler echocardiographic variables were compared between patients with and without rejection, and their predictive ability for detecting rejection was determined by uni- and multivariate analyses.


RESULTS
In 268 biopsies there was no significant rejection (ISHLT Grade <==II), whereas 138 showed rejection (ISHLT Grade > or =IIIa). By multivariate analysis, pericardial effusion, isovolumic relaxation time (IVRT) <90 milliseconds and mitral inflow E/A ratio >1.7, diameter of inferior vena cava and duration of pulmonary vein atrial reversal were independently associated with rejection. Because the odds ratios were similar for all 5 predictors, a simplified model was developed based on the sum of the number of abnormal predictors present (0 to 5). The probability of rejection increased from 15.9%, in the absence of any predictor, to 39.7%, 52.0% and 71.1%, if 1, 2 or 3 predictors were present, respectively.


CONCLUSIONS
Recipient age, pericardial effusion, IVRT and ratio of pulsed Doppler E/A are significant predictors of acute cardiac allograft rejection. However, no single predictor or combination of predictors were powerful enough to eliminate surveillance endomyocardial biopsies.
Sun
Jing Ping
JP
Cardiovascular Imaging Center and Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Abdalla
Ibrahim A
IA
Asher
Craig R
CR
Greenberg
Neil L
NL
Popović
Zoran B
ZB
Taylor
David O
DO
Starling
Randall C
RC
Thomas
James D
JD
Garcia
Mario J
MJ
D000328:Adult; D000368:Aged; D001706:Biopsy; D001783:Blood Flow Velocity / Q000502:physiology; D004452:Echocardiography; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity