Evaluation of the Role of Conventional and Tissue Doppler Imaging Echocardiography in Detection of Acute Cardiac Allograft Rejection in Heart Transplant Recipients

Background: Endomyocardial Biopsy (EMB) is the gold standard test for diagnosis of acute allograft cardiac rejection. Objectives: The present study aimed to assess the role of echocardiographic parameters in discriminating patients with and without evidence of acute cardiac allograft rejection. Materials and Methods: In the present cross-sectional study, using convenience sampling, 63 EMB specimens were collected from the patients who had undergone biatrial orthotropic cardiac transplantation. The mean age of the recipients and donors was 30.46 +/- 9.49 and 24.55 +/- 7.64 years, respectively. There were 51(81%) male recipients and 39(62%) male donors. Echocardiographic examination was performed within the 24 hours of EMB. The data were entered into the SPSS statistical software, version 19 and were analyzed by chi-square test, student's t-test, and one-way ANOVA as appropriated. All the data were two-tailed and P < 0.05 was considered to be statistically significant. Results: Among the 63 EMB specimens evaluated in the present study, mild and moderate acute rejections were seen in 19(30%) and 5(8%) cases, respectively. On Doppler examination, the three groups (without rejection, with mild rejection, and with moderate acute rejection) were significantly different only regarding trans-tricuspid E wave (P = 0.040). Pulsed-wave Tissue Doppler Imaging (TDI) also revealed a significant difference between the patients with and without allograft rejection regarding early diastolic tricuspid and mitral annular motion velocities (P = 0.005 and P = 0.02, respectively). Conclusions: It seems that echocardiographic parameters, including TDI, might be adjunct to, rather than substitution for, EMB findings for early diagnosis of acute allograft rejection.