Ja. Puleo et al., NONINVASIVE DETECTION OF ALLOGRAFT-REJECTION IN HEART-TRANSPLANT RECIPIENTS BY USE OF DOPPLER TISSUE IMAGING, The Journal of heart and lung transplantation, 17(2), 1998, pp. 176-184
Citations number
23
Categorie Soggetti
Cardiac & Cardiovascular System",Transplantation,"Respiratory System
Background: Allograft rejection in heart transplant recipients is asso
ciated with lymphocytic extracellular infiltration and edema resulting
in increased myocardial stiffness and abnormal relaxation. We hypothe
size that these abnormalities will result in reduced myocardial relaxa
tion velocities. Doppler tissue imaging is a novel noninvasive imaging
modality that is capable of quantifying myocardial tissue velocities
and may therefore be useful to identify allograft rejection. Methods:
In this observational study, 121 heart transplant recipients underwent
pulsed-wave Doppler tissue imaging at the time of their surveillance
endomyocardial biopsies. Peak relaxation and systolic velocities were
measured from the inferior wall blinded to clinical biopsy. Biopsy res
ults were classified as rejecting (3a, 3b, 4) or nonrejecting (0, 1a,
1b). Results: The peak relaxation velocity in nonrejecting allograft r
ecipients (n = 98) was 0.21 m/sec +/- 0.01. During moderate allograft
rejection (n = 16), peak relaxation velocities decreased to 0.14 m/sec
+/- 0.01 (p < 0.0001), and subsequently increased to 0.23 m/sec +/- 0
.0 after successful treatment (p = 0.0001). Peak systolic velocities d
id not change during rejection, 0.08 m/sec +/- 0.02 when compared with
nonrejecting recipients 0.09 +/- 0.02 (p = NS). With a cutoff value o
f less than 0.16 m/sec, the sensitivity of peak myocardial relaxation
velocities for detection of rejection was 76%. The specificity and neg
ative predictive values were 88% and 92%, respectively. Conclusion: Mo
derate allograft rejection results in reduced myocardial relaxation ve
locities, which can be detected noninvasively with pulsed-wave Doppler
tissue imaging. Hence, Doppler tissue imaging is a useful noninvasive
tool to exclude allograft rejection.