Echocardiographic abnormalities with acute cardiac allograft rejection in children: correlation with endomyocardial biopsy

In patients who have undergone successful orthotopic heart transplantation, echocardiography has the potential to be a noninvasive method for rejection surveillance that would reduce the frequency and guide the timing of endomyocardial biopsies, as well as allow for more frequent monitoring, with less cost and risk to the patient. To determine the applicability of echocardiography to detect moderate to severe rejection in children, 26 two-dimensional-guided M-mode echocardiograms with Doppler/color flow mapping were performed within 24 hours of endomyocardial biopsy. M-mode echocardiograms of the left ventricle were digitized and analyzed with a computer-assisted measurement format for left ventricular size, mass, and wall motion in systole and diastole. These echocardiographic parameters were clustered and analyzed by a unique echocardiographic scoring algorithm blinded to the biopsy interpretation. In eight cases in which findings of biopsies were consistent with moderate to severe rejection, left ventricular mass was increased and indexes of systolic and diastolic function were depressed compared with the remainder of the cases (n = 18), in which findings of biopsies included either no evidence or mild evidence of rejection. The echocardiographic score of the group with moderate to severe rejection was significantly greater than the score of the group that was normal or had mild rejection (5.4 +/- 0.7 vs 2.2 +/- 0.3; p0.001). With rejection prospectively defined as an echocardiographic score of greater than or equal to score 4, echocardiography achieved 88% sensitivity and 83% specificity in detecting moderate to severe rejection.(ABSTRACT TRUNCATED AT 250 WORDS)