Usefulness of the combined index of systolic and diastolic myocardial performance to identify cardiac allograft rejection
Section snippets
Study patients
The study consisted of 40 patients (28 men and 12 women) who survived orthotopic heart transplantation between 1996 and 1999 at the Ochsner Heart and Vascular Institute in New Orleans, Louisiana. All patients underwent serial echocardiographic examination within 2 hours before endomyocardial biopsy. The biopsy samples, after histopathologic analysis, were graded per standard ISHLT grading.10 The biopsy grade and echocardiographic indexes were analyzed in a blinded fashion.
M-mode, 2-dimensional, and doppler echocardiography
Echocardiographic
Patient characteristics
The baseline patient characteristics are listed in Table 1. There was no significant difference between the 2 groups with regard to age, sex, systemic hypertension, diabetes, and immunosuppressive regimen.
Correlation of the change in IMP with cardiac allograft rejection
On serial assessment of the change of IMP in group I patients (Figure 2), there was a statistically significant 98% increase of IMP during high-grade cellular rejection (0.42 ± 0.18 to 0.83 ± 0.33; p <0.0001). In contrast, IMP in group II patients (Figure 2) had no significant change over
Discussion
Cardiac allograft rejection affects systolic and diastolic myocardial performance.11 A new Doppler index, combining systolic and diastolic time intervals as an expression of global myocardial performance, has been shown to be of prognostic value in patients with dilated cardiomyopathy and infiltrative heart diseases (e.g., cardiac amyloidosis).8, 9 Our study has shown that this index is very helpful in identifying high-grade cellular cardiac allograft rejection. It should be emphasized that the
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