BACKGROUND: Heart transplant recipients require frequent myocardial biopsies to screen for acute rejection. The purpose of this study was to identify demographic and echocardiographic factors associated with transplant rejection and develop a predictive model, which may reduce the number of cardiac biopsies. METHODS: From January 1998 to December 2001, we performed 406 echocardiographic studies on 264 heart transplant patients who had biopsies performed on the same day. Two-dimensional, pulsed and tissue Doppler echocardiographic variables were compared between patients with and without rejection, and their predictive ability for detecting rejection was determined by uni- and multivariate analyses. RESULTS: In 268 biopsies there was no significant rejection (ISHLT Grade <==II), whereas 138 showed rejection (ISHLT Grade > or =IIIa). By multivariate analysis, pericardial effusion, isovolumic relaxation time (IVRT) <90 milliseconds and mitral inflow E/A ratio >1.7, diameter of inferior vena cava and duration of pulmonary vein atrial reversal were independently associated with rejection. Because the odds ratios were similar for all 5 predictors, a simplified model was developed based on the sum of the number of abnormal predictors present (0 to 5). The probability of rejection increased from 15.9%, in the absence of any predictor, to 39.7%, 52.0% and 71.1%, if 1, 2 or 3 predictors were present, respectively. CONCLUSIONS: Recipient age, pericardial effusion, IVRT and ratio of pulsed Doppler E/A are significant predictors of acute cardiac allograft rejection. However, no single predictor or combination of predictors were powerful enough to eliminate surveillance endomyocardial biopsies.
BACKGROUND: Heart transplant recipients require frequent myocardial biopsies to screen for acute rejection. The purpose of this study was to identify demographic and echocardiographic factors associated with transplant rejection and develop a predictive model, which may reduce the number of cardiac biopsies. METHODS: From January 1998 to December 2001, we performed 406 echocardiographic studies on 264 heart transplant patients who had biopsies performed on the same day. Two-dimensional, pulsed and tissue Doppler echocardiographic variables were compared between patients with and without rejection, and their predictive ability for detecting rejection was determined by uni- and multivariate analyses. RESULTS: In 268 biopsies there was no significant rejection (ISHLT Grade <==II), whereas 138 showed rejection (ISHLT Grade > or =IIIa). By multivariate analysis, pericardial effusion, isovolumic relaxation time (IVRT) <90 milliseconds and mitral inflow E/A ratio >1.7, diameter of inferior vena cava and duration of pulmonary vein atrial reversal were independently associated with rejection. Because the odds ratios were similar for all 5 predictors, a simplified model was developed based on the sum of the number of abnormal predictors present (0 to 5). The probability of rejection increased from 15.9%, in the absence of any predictor, to 39.7%, 52.0% and 71.1%, if 1, 2 or 3 predictors were present, respectively. CONCLUSIONS: Recipient age, pericardial effusion, IVRT and ratio of pulsed Doppler E/A are significant predictors of acute cardiac allograft rejection. However, no single predictor or combination of predictors were powerful enough to eliminate surveillance endomyocardial biopsies.
Authors: David R Okada; Maria R Molina; Maria Kohari; Esther E Vorovich; Anjali T Owens; Yuchi Han Journal: Int J Cardiovasc Imaging Date: 2015-02-21 Impact factor: 2.357
Authors: Ritu Sachdeva; Sadia Malik; Paul M Seib; Elizabeth A Frazier; Mario A Cleves Journal: Int J Cardiovasc Imaging Date: 2010-11-10 Impact factor: 2.357
Authors: Cecilia Beatriz Bittencourt Viana Cruz; Ludhmila A Hajjar; Fernando Bacal; Marco S Lofrano-Alves; Márcio S M Lima; Maria C Abduch; Marcelo L C Viera; Hsu P Chiang; Juliana B C Salviano; Isabela Bispo Santos da Silva Costa; Julia Tizue Fukushima; Joao C N Sbano; Wilson Mathias; Jeane M Tsutsui Journal: Cardiovasc Ultrasound Date: 2021-01-09 Impact factor: 2.062
Authors: Karolina Antończyk; Tomasz Niklewski; Remigiusz Antończyk; Michael Zakliczyński; Marian Zembala; Tomasz Kukulski Journal: Ann Transplant Date: 2018-08-08 Impact factor: 1.530