title: Role of echocardiography in the ventricular assessment of the transplanted heart versus heart rejection.
abstract: BACKGROUND
  Heart transplantation is an alternative for individuals with end-stage heart disease. However, episodes of heart rejection (HR) are frequent and increase morbidity and mortality, requiring the use of an accurate non-invasive exam for their diagnosis, since endomyocardial biopsy (EMB) is not a complication-free procedure.
  
  
  OBJECTIVE
  To compare the parameters obtained by use of Doppler echocardiography in a group of transplanted patients with HR (TX1) and another group of transplanted patients without rejection (TX0), having as reference a control group (CG) and observing the behavior of the left ventricular systo-diastolic function expressed as the myocardial performance index (MPI) METHODS: Transthoracic echocardiographies were performed from January 2006 to January 2008 to prospectively assess 47 patients divided into three groups: CG (36.2%); TX0 (38.3%); and TX1 (25.5%). The MPI was compared between the groups, and data were analyzed by use of Fisher exact test and nonparametric Kruskal-Wallis test, both with significance level of 5%.
  
  
  RESULTS
  The groups did not differ regarding age, weight, height, and body surface. When compared to GC, TX0 and TX1 showed a change in the left ventricular systo-diastolic function, expressed as an increase in MPI, which was greater in TX1 [0.38 (0.29 - 0.44); 0.47 (0.43 - 0.56); 0.58 (0.52 - 0.74), respectively; p < 0.001].
  
  
  CONCLUSIONS
  Echocardiography was a very accurate test to detect changes in the systo-diastolic function of the transplanted heart; however, it did not prove to be reliable to replace BEM in the safe diagnosis of HR.
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, Hospital São Joaquim, São Paulo, Brazil. gasmiguel@cardiol.br
authors.forename: Gabriel Antonio Stanisci
authors.initials: GA
authors.lastname: Miguel
authors.forename: Salomón Soriano Ordinola
authors.initials: SS
authors.lastname: Rojas
authors.forename: Reinaldo Wilson
authors.initials: RW
authors.lastname: Vieira
authors.forename: José Pedro da
authors.initials: JP
authors.lastname: Silva
authors.forename: Henry
authors.initials: H
authors.lastname: Abensur
mesh_terms: D000328:Adult; D017677:Age Distribution; D001706:Biopsy; D015150:Echocardiography, Doppler; D004812:Epidemiologic Methods; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000473:pathology; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D017678:Sex Distribution; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016276:Ventricular Function / Q000502:physiology*