HEART-VOLUME AS AN INDICATOR FOR REJECTIO N IN ORTHOTOPIC CARDIAC TRANSPLANTATION

Endomyocardial biopsy in cardiac transplantation is still the most exa ct test (gold standard) to confirm or exclude a suspected rejection. U p to now, all available noninvasive tests suffer from a low sensitivit y and specificity. For a further reduction of biopsies early available noninvasive methods are desirable. In the data presented a comparison between histological findings and heart volume measurements is shown in 40 patients (112 histological findings) after orthotopic cardiac tr ansplantation. In 46 cases with no evidence of histological rejection the echocardiographically or radiologically determined heart volume wa s 869 +/- 142 ml/1.73 m2 body surface area, compared to 1026 +/- 178 m l/1.73 m2 in 29 cases with mild cardiac rejection. In 37 cases with a moderate or severe rejection heart volume was 1094 +/- 181 ml/1.73 m2. The diagnosis of a moderate or severe rejection by biopsy is combined with a heart volume above 950 ml/1.73 m2 with a sensitivity of 78% an d a specificity of 73%. Intramyocardial edema as well as an increase i n right and left ventricular volumes due to heart failure may be the c auses for heart volume increase in rejection. Thus, heart volume measu rement which can be performed easily during routine echocardiography g ives additional information about whether a rejection has to be assume d or can be excluded. Today, sensitivity and specificity of the test d oes not allow a reduction of biopsy frequency. Further investigations are necessary to analyze the course of heart volume changes during an episode of rejection.