title: Noninvasive diagnosis of cardiac allograft rejection using echocardiography indices of systolic and diastolic function.
abstract: BACKGROUND
  Limited and conflicting data exist on the diagnosis of cardiac allograft rejection with the use of echocardiography. The purpose of our study was to evaluate various systolic and diastolic indices, including newer tissue Doppler imaging techniques, in diagnosing cardiac allograft rejection.
  
  
  METHODS
  We prospectively performed 426 echocardiography studies at the time of endomyocardial biopsy in 54 cardiac transplant patients. We measured left ventricular (LV) systolic and diastolic dimensions, mitral inflow pattern and annular velocities, and the myocardial performance index. Biopsies were assessed for cellular rejection and antibody-mediated rejection (AMR).
  
  
  RESULTS
  Mild cellular rejection was diagnosed in 74 biopsy specimens and significant cellular rejection in 10 biopsy specimens. AMR was diagnosed in 30 biopsy specimens. In patients with mild or significant cellular rejection, no significant differences in echocardiographic parameters were observed. In patients with AMR, LV fractional shortening was significantly reduced compared with those with no AMR (mean±SD 31.8±8.9% vs 36.0±7.1%; P=.02).
  
  
  CONCLUSIONS
  Although 1 echocardiographic parameter was statistically different in the setting of rejection, lack of consistency and overlap between nonrejection and rejection groups does not permit definitive noninvasive diagnosis of cardiac allograft rejection using this imaging modality.
authors.affiliation: Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. feras.bader@hsc.utah.edu
authors.forename: F M
authors.initials: FM
authors.lastname: Bader
authors.forename: N
authors.initials: N
authors.lastname: Islam
authors.forename: N A
authors.initials: NA
authors.lastname: Mehta
authors.forename: N
authors.initials: N
authors.lastname: Worthen
authors.forename: S
authors.initials: S
authors.lastname: Ishihara
authors.forename: J
authors.initials: J
authors.lastname: Stehlik
authors.forename: E M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: S E
authors.initials: SE
authors.lastname: Litwin
mesh_terms: D001706:Biopsy; D003971:Diastole; D015150:Echocardiography, Doppler; D006084:Graft Rejection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D013599:Systole; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014589:Utah; D016277:Ventricular Function, Left