NONINVASIVE DIAGNOSIS OF CARDIAC ALLOGRAFT-REJECTION BY MEANS OF PULSED DOPPLER AND M-MODE ULTRASOUND

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 < 0.01), PHT (51 versus 43 ms; P < 0.001), VTI-E (72 versus 57 mm; P < 0.001), and IVRP (90 versus 73 ms; P < 0.001). During rejection, heart rate increased significantly from 78 to 91 beats per minute (P < 0.01). Furthermore, a significant decrease was found for PEV from 73 to 63 cm/s (P < 0.01), for PHT from 52 to 40 ms (P < 0.001), for VTI-E from 75 to 61 mm (P < 0.001), and for IVRP from 90 to 74 ms (P < 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.