title: Tissue doppler echocardiography in the diagnosis of heart transplantation rejection.
abstract: BACKGROUND
  Endomyocardial biopsy (EMB) is the gold standard method for the diagnosis of cellular rejection (CR) after heart transplantation (HT).
  
  
  OBJECTIVE
  To test the hypothesis that tissue Doppler imaging (TDI) could detect CR > 3A and add diagnostic information compared to conventional Doppler.
  
  
  METHODS
  Fifty-four HT patients underwent 129 EMB and a TDI echocardiographic study within 24 hours. We compared HT patients with CR > 3A versus HT patients with CR < 3A, with a normal matched control group (13 patients). We measured TDI systolic (S), early diastolic (e'), late diastolic (a') velocities and e'/a' ratio in the left ventricular annulus, basal and medium (mid) segments of the septal (SEP), lateral (LAT), inferior (INF), anterior (ANT) walls; and in the right ventricular annulus.
  
  
  RESULTS
  HT patients showed CR > 3A in 39/129 (30.2%) EMB. The best isolated predictor for CR diagnosis was a'LAT, with a sensitivity of 76.3%, specificity of 73.8% (p = 0.001). In the multivariate analysis, a'LAT (p = 0.001), a'SEP (p = 0.002), e'/a' LAT ratio (p = 0.006), e'Mitral/ e'LAT ratio (p = 0.014), SINF (p = 0.009) predicted CR > 3A. We obtained a score with a sensitivity of 88.2%, accuracy of 79.6% and negative predictive value of 92.9% to diagnose CR > 3A. Conventional Doppler (mitral and pulmonary venous flow) was not relevant to predict CR > 3A.
  
  
  CONCLUSIONS
  TDI added diagnostic information to predict CR > 3A compared to conventional Doppler. A TDI-based model could become a potential method to detect CR > 3A after heart transplantation.
authors.affiliation: Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, SP, Brazil. mlvieira@cardiol.br
authors.forename: Marcos Valério Coimbra
authors.initials: MV
authors.lastname: Resende
authors.forename: Marcelo Luiz Campos
authors.initials: ML
authors.lastname: Vieira
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: José Lázaro
authors.initials: JL
authors.lastname: Andrade
authors.forename: Noedir A
authors.initials: NA
authors.lastname: Stolf
authors.forename: Edmar Alcides
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000473:pathology; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000473:pathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult