COMPARISON OF QUANTITATIVE ECHOCARDIOGRAPHY WITH ENDOMYOCARDIAL BIOPSY TO DEFINE MYOCARDIAL REJECTION IN PEDIATRIC-PATIENTS AFTER CARDIAC TRANSPLANTATION

Endomyocardial biopsy is the gold standard for determining rejection; however, no echocardiographic indexes have been widely accepted as ind icators of rejection. The stress-velocity relation of corrected veloci ty of circumferential fiber shortening to wall stress is a preload ind ependent index of contractility that incorporates afterload and has be en shown to distinguish a decreased velocity caused by excess afterloa d from that caused by decreased contractility. Wall stress has not bee n previously reported as a determinant of rejection. We report a prosp ective double-blind study of pediatric cardiac transplant patients com paring biopsy and quantitative systolic echocardiographic data. Thirty -two pediatric patients underwent 67 biopsies. At the time of catheter ization, an echocardiographic evaluation was performed. Standard measu rements of systolic function were collected and left ventricular (LV) fractional shortening, LV volume, LV mass, velocity of circumferential fiber shortening, and estimated end-systolic wall stress were calcula ted. In evaluating echocardiographic data of patients with and without biopsy-proven rejection, we were unable to identify any significant c orrelation between any systolic echocardiographic parameter and reject ion, We conclude that: (1) the stress-velocity relation does not detec t myocardial rejection; and (2) neither LV fractional shortening, LV v olume, nor LV mass detect rejection; and (3) central venous pressure i nfluence wall stress values significantly. (C) 1997 by Excerpta Medica , Inc.