VALUE OF DOPPLER-ECHOCARDIOGRAPHY IN THE DETECTION OF LOW-GRADE REJECTIONS AFTER CARDIAC TRANSPLANTATION

Modifications of the diastolic parameters pressure half-time (PHT) and isovolumic relaxation time (IVRT), recorded using cardiac Doppler ech ocardiography (CDE), were studied in 23 heart transplant recipients an d compared to the results of 345 endomyocardial biopsies (EMB) perform ed on the same day. Two different protocols, analyzing respectively (1 ) a decrease of 20 % or more in IVRT and/or PHT with respect to the me an and (2) a decrease of 20 % or more in IVRT and/or PHT with respect to its preceding value, were used to evaluate the efficiency of CDE in diagnosing mild and moderate rejections. When a mild rejection was de tected by EMB, a statistically significant decrease was found in the a verage CDE parameter values of the patient population. However, these variations were weak and did not differ from the spontaneous variation s observed in each patient in the absence of rejection. Thus, it is no t surprising that the sensitivity of CDE in the detection of mild reje ctions was very low (45 %) using the most sensitive protocol (variatio ns of the parameters from their preceding value). We conclude that CDE alone does not seem to be sufficient to perform the noninvasive diagn osis of low-grade rejections and must be complemented by other noninva sive methods.