Echocardiographic assessment of cardiac allograft rejection

Abstract

Twenty-one patients surviving orthotopic cardiac transplantation were studied by serial M-Mode and cross-sectional echocardiography on the same day as endomyocardial biopsy (EBS) (n = 205) during a mean follow-up period of 7.7 ± 6 months. Results of EBS and the corresponding echocardiograms were divided into three groups: (1) no rejection (62 patients); (2) onset of mild rejection (11 patients); (3) onset of moderate rejection (17 patients). Groups 1 and 3 differed significantly in interventricular septum plus posterior wall thickness (IVS+PWth) (P<0.001), LV mass (P<0.001), LV ejection fraction (LVEF) (P<0.001), increased myocardial echo–genicity (ME) (P<0.01), impaired RV wall motion (P<0.001). Groups 1 and 2 differed significantly only in increased ME (P<0.01). Groups 2 and 3 differed significantly in IVS+PWth (P<0.05), LV mass (P<0.01), LVEF (P<0.01), and impaired RVwall motion (P<0.01). With acute rejection we observed (1) increase of <4mm in IVS+PWth (55%), (2) increase of 30% in LV mass (34%), (3) reduction of <10 points in LVEF (27%), (4) RV dilatation and wall motion impairment (31%), (5) appearance or marked increase of per icar dial effusion (34%), (6) increased ME (58%). Specificity of the individual criteria ranged from 95-6% to 100%. If only one of the above changes was used for echocardiographic diagnosis of rejection, 89% sensitivity and 90% specificity were found; if two or more of the above criteria were considered for diagnosis, specificity rose to 100% and sensitivity decreased to 72% Echocardiography provides a promising non-invasive tool for the detection of the onset of acute rejection, particularly if the diagnosis is based on a multiparametric evaluation of serial changes.