Evaluation of the potential role of color-coded tissue Doppler echocardiography in the detection of allograft rejection in heart transplant recipients

Background Color-coded tissue Doppler (TD) echocardiography can noninvasive ly quantify alterations in left ventricular (LV) systolic and diastolic fun ction. The objective of this study was to test the hypothesis that TD may p lay a role in the detection of LV dysfunction associated with allograft rej ection in heart transplant recipients. Methods and Results Seventy-eight consecutive transplant recipients underwe nt 89 TD studies of posterior wall myocardial velocity gradient and mitral annular velocity within 1 hour of endomyocardial biopsy. Color TD echocardi ographic images were digitized for semiautomated computer analysis. Histolo gic analysis revealed no significant rejection in 75 biopsies and significa nt rejection in 14. TD posterior wall peak systolic and diastolic velocity gradients were reduced significantly with rejection: 3.9 +/- 2.0 s(-1) vers us 2.6 +/- 0.9 s(-1) and 5.4 +/- 2.4 s(-1) versus 3.5 +/- 1.6 s(-1), respec tively (P < .05 vs the nonrejecting group). Peak systolic and diastolic mit ral annular velocities by TD were also reduced with rejection: 63 +/- 14 mm /s versus 49 +/- 12.4 mm/s and 90 +/- 23 mm/s versus 60 +/- 21 mm/s, respec tively (P < .001 vs the nonrejecting group). A TD peak-to-peak mitral annul ar velocity >135 mm/s had 93% sensitivity, 71% specificity, and 98% negativ e predictive value for detecting rejection. Although TD was unable to discr iminate between rejection and other causes of low velocity values, high TD velocity Values were supportive of excluding rejection. Conclusions These data suggest that color-coded TD may play a potential rol e as a screening test to exclude rejection in heart transplant recipients. Although this method has the potential to decrease the number of biopsies, further testing in a larger series of transplant recipients with rejection is warranted.