DETECTION OF ACUTE REJECTION AFTER CARDIAC TRANSPLANTATION BY DOPPLERTISSUE IMAGING

Doppler tissue imaging is a new technique of measuring the velocities of myocardial wall motion. In order to assess its value in the diagnos is of acute rejection, the velocities of the interventricular septum a nd left ventricular posterior wall were measured in systole and early diastole in 34 cardiac transplant patients at the time of their endomy ocardial biopsy, using an M mode left parasternal short axis view. Dur ing 40 episodes of acute rejection (26 mild and/or moderate, 10 sub-se vere and 4 severe), the wall velocities decreased significantly (p< 0. 001) both in the interventricular septum and endocardium of the poster ior wall. Myocardial velocities were significantly slower in sub-sever e or severe rejection than in mild or moderate rejection. The most sen sitive criterion was the measurement of posterior wall endocardial vel ocity in early diastole, a decrease of 10% having a sensitivity of 92% whereas the sensitivity of usual Doppler echocardiographic parameters is only 73%. Acute rejection, even mild cases, can be diagnosed with excellent sensitivity by measuring myocardial velocities by Doppler ti ssue imaging. This technique has the advantage of being non-invasive, reproducible and reliable in the follow-up of cardiac transplant patie nts.