Journal of Ultrasound in Medicine, Vol 10, Issue 10 569-575, Copyright © 1991 by American Institute of Ultrasound in Medicine
Noninvasive diagnosis of cardiac allograft rejection by means of pulsed Doppler and M-mode ultrasound
T. Stork, M. Mockel, H. Eichstadt, T. Walkowiak, H. Siniawski, R. Muller, R. Hetzer and H. Hochrein
Department of Cardiology and Intensive Care, University Hospital Rudolf Virchow, Berlin, Germany.
The changes of left ventricular (LV) diastolic function associated with
cardiac rejection were evaluated. Twenty-one cardiac allograft recipients
aged 41 +/- 9 years, 11 with moderate to severe and 10 allograft rejection
without rejection at myocardial biopsy underwent serial echo examination,
including peak velocity (PEV), pressure half-time (PHT), velocity-time
integral (VTI-E) of early mitral flow, and isovolumetric relaxation period
(IVRP). In transplant recipients, significantly higher values than in 22
age-matched healthy controls were found for PEV (71 versus 56 cm/s; P less
than 0.01), PHT (51 versus 43 ms; P less than 0.001), VTI-E (72 versus 57
mm; P less than 0.001), and IVRP (90 versus 73 ms; P less than 0.001).
During rejection, heart rate increased significantly from 78 to 91 beats
per minute (P less than 0.01). Furthermore, a significant decrease was
found for PEV from 73 to 63 cm/s (P less than 0.01), for PHT from 52 to 40
ms (P less than 0.001), for VTI-E from 75 to 61 mm (P less than 0.001), and
for IVRP from 90 to 74 ms (P less than 0.001) during cardiac rejection.
Thus, sonographic evaluation of LV diastolic function helps to early detect
cardiac rejection and to decrease the frequency of myocardial biopsy.
