Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection

Objective-To test the hypothesis that diastolic mitral annular motion veloc ity as determined by Doppler tissue imaging and left ventricular diastolic flow propagation velocity, is related to the histological degree of heart t ransplant rejection according to the International Society of Heart and Lun g Transplantation (ISHLT). Methods-In 41 heart transplant recipients undergoing 151 myocardial biopsie s, the following Doppler echocardiographic measurements were performed with in one hour of biopsy: transmittal and pulmonary vein flow indices; mitral annular motion velocity indices; left ventricular diastolic flow propagatio n velocity. Results-Late diastolic mitral annular motion velocity (A(DTI)) and mitral a nnular systolic contraction velocity (SCDTI) were higher in patients with I SHLT < IIIA than in those with ISHLT greater than or equal to IIIA (A(DTI), 8.8 cm/s v 7.7 cm/s (p = 0.03); SCDTI, 19.3 cm/s v 9.3 cm/s (p < 0.05)). S ensitivity and specificity of A(DTI) < 8.7 cm/s (die best cut off value) in predicting significant heart transplant rejection were 82% and 53%, respec tively. Early diastolic mitral annular motion velocity (E-DTI) and flow pro pagation velocity were not related to the histological degree of heart tran splant rejection. Conclusions-Doppler tissue imaging of the mitral annulus is useful in diagn osing heart transplant rejection because a high late diastolic mitral annul ar motion velocity can reliably exclude severe rejection. However, a reduce d late diastolic mitral annular motion velocity cannot predict severe rejec tion reliably because it is not specific enough.