ECHOCARDIOGRAPHIC ABNORMALITIES WITH ACUTE CARDIAC ALLOGRAFT-REJECTION IN CHILDREN - CORRELATION WITH ENDOMYOCARDIAL BIOPSY

In patients who have undergone successful orthotopic heart transplanta tion, echocardiography has the potential to be a noninvasive method fo r rejection surveillance that would reduce the frequency and guide the timing of endomyocardial biopsies, as well as allow for more frequent monitoring, with less cost and risk to the patient. To determine the applicability of echocardiography to detect moderate to severe rejecti on in children, 26 two-dimensional-guided M-mode echocardiograms with Doppler/color flow mapping were performed within 24 hours of endomyoca rdial biopsy. M-mode echocardiograms of the left ventricle were digiti zed and analyzed with a computer-assisted measurement format for left ventricular size, mass, and wall motion in systole and diastole. These echocardiographic parameters were clustered and analyzed by a unique echocardiographic scoring algorithm blinded to the biopsy interpretati on. In eight cases in which findings of biopsies were consistent with moderate to severe rejection, left ventricular mass was increased and indexes of systolic and diastolic function were depressed compared wit h the remainder of the cases (n = 18), in which findings of biopsies i ncluded either no evidence or mild evidence of rejection. The echocard iographic score of the group with moderate to severe rejection was sig nificantly greater than the score of the group that was normal or had mild rejection (5.4 +/- 0.7 vs 2.2 +/- 0.3; p < 0.001). With rejection prospectively defined as an echocardiographic score of greater than o r equal to score 4, echocardiography achieved 88% sensitivity and 83% specificity in detecting moderate to severe rejection. When the echoca rdiographic score was less than 4 the probability of not detecting rej ection was only 6% (negative predictive value = 94%). Inclusion of mul tiple parameters that reflect echocardiographically determined left ve ntricular mass and systolic and diastolic function may overcome indivi dual patient variability to achieve a simple screening tool (echocardi ography) for the detection of moderate and severe rejection in childre n after heart transplantation.