Alteration of Left Ventricular Filling Evaluated by Doppler Echocardiography as a Potential Marker of Acute Rejection in Orthotopic Heart Transplant

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Abstract
To evaluate the changes in left ventricular (LV) filling associated with acute cardiac rejection, serial Doppler echocardiographic (ED) examinations were performed on the same day as endomyocardial biopsy (EMB) in 40 patients who underwent orthotopic transplantation. The diameters and wall thickness of the left ventricle were measured. The indexes of LV filling in the following parameters were measured by pulsed Doppler: isovolumic relaxation time (IRT), peak early mitral flow velocity (V max E), and pressure half-time (PHT). The patients were classified into three groups on the basis of EMB: Group I (19 patients without rejection), Group II (11 patients with mild or moderate rejection), and Group III (10 patients with severe rejection).In Group III rejection was associated with a significant increase of posterior wall thickness (P < 0.05), with a decrease of IRT (P < 0.05), and an increase of V max E velocity (P < 0.01) in comparison with Group I. In Group II, Doppler indexes were not statistically significant in comparison with Groups I and III.In conclusion, in transplant patients, a diagnosis of acute cardiac rejection can be suspected in severe rejection by use of echocardiography when the diagnosis is based on a multiparametric evaluation of different ED indexes (m-mode and Doppler indexes). Doppler echocardiography is a method with an excellent specificity but insufficient sensitivity ; this is due to the influence of recipient atrial contraction timing on Doppler indexes of LV filling.