NONINVASIVE MARKERS FOR ACUTE HEART-TRANSPLANT REJECTION IN CHILDREN WITH THE USE OF AUTOMATIC BORDER DETECTION

A noninvasive method to-detect heart transplant rejection would allow for increased monitoring at reduced risk. Automatic border detection i s a new method to assess diastolic abnormalities. The purpose of this study was to determine whether automatic border detection of left vent ricular filling detects rejection in children, Nineteen episodes of bi opsy-proven rejection in 10 children were retrospectively reviewed. Ec hocardiograms during rejection were compared with those before rejecti on and during recovery. Automatic border detection indices were percen tage of total left ventricular filling as a result-of rapid filling, d iastasis, and atrial contraction. The percentage of total ventricular filling during diastasis increased significantly during rejection (10% +/- 6% versus 15% +/- 8%, P = 0.02), and the percentage of filling du ring the rapid filling phase decreased during rejection (82% +- 8% ver sus 77% +/- 11%, P = 0.08). These changes were even more marked for th e most severe episodes of rejection. These changes resolved at recover y. Automatic border detection of left ventricular filling patterns are altered during cardiac rejection in children. Filling during diastasi s increases significantly, and filling during the rapid filling phase decreases. A prospective analysis is needed to determine whether these changes in filling can obviate the need for cardiac biopsy.