Reliability of Tissue Doppler Wall Motion Monitoring After Heart Transplantation for Replacement of Invasive Routine Screenings by Optimally Timed Cardiac Biopsies and Catheterizations

Abstract

Background-Invasive screenings at predefined time intervals for acute rejection and transplant coronary artery disease (TxCAD) are standard procedures. However, cardiac biopsies and catheterizations are distressing and risky for the patients and are also costly. We assessed the reliability of pulsed-wave tissue Doppler imaging (PW-TDI) for the timing of invasive examinations in heart recipients in an attempt to avoid unnecessary endomyocardial biopsies (EMBs) and catheterizations. Methods and Results-PW-TDI obtained at the basal left ventricular posterior wall before 408 EMBs and 293 catheterizations was tested for its diagnostic value regarding rejection and TxCAD with the use of International Society of Heart and Lung Transplantation biopsy grading, coronary angiography, and intravascular ultrasound as standards.Early diastolic peak wall motion velocity and relaxation time showed high sensitivities for clinically relevant rejection diagnosis (90.0% and 93.3%, respectively). The negative and positive predictive values for rejection of diastolic parameter changes appeared high enough (up to 96% and 92%, respectively) to allow a reliable noninvasive PW-TDI monitoring with efficiently timed, instead of routinely scheduled, EMBs. At definite cutoff values for systolic parameters, the probability for TxCAD reached 92% to 97%. The Fisher classification functions allowed TxCAD exclusion with 80% probability. Conclusions-Without diastolic parameter changes, acute rejection can be practically excluded, and serial PW-TDI can save patients from routine EMBs. The high specificity and negative predictive value for TxCAD of reduced systolic peak velocities and extended systolic time allow optimized timed catheterizations. Peak systolic velocity and systolic time allow diagnostic classifications that enable patients without known TxCAD but with high risk for catheterization to be spared routine angiographies. (Circulation. 2001;104[suppl I]:I-184-I-191.)

The subclinical effect of celiac disease on the heart and the effect of gluten-free diet on cardiac functions

“…It has been widely accepted that tissue Doppler echocardiography (TDE) is useful in analyzing subclinical ventricular functions in some cases such as valve regurgitation, anthracycline cardio toxicity, earlier phases of cardiomyopathies and heart transplant rejection [5][6][7][8] . However, the number of studies on TDE's role in analyzing cardiac functions, and the spectrum and frequency of cardiac involvement in children with CD is limited 9,10 .…”

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“…8 It has been observed that early diastolic peak velocity and isovolumetric relaxation time in the basal portion of the left ventricle lateral wall measured by pulse wave tissue Doppler had a high sensitivity in diagnosing rejection, especially those higher than grade II. 9 Stengel and associates 10 reported that high late diastolic mitral annulus velocity was effective in diagnosis of grade III and higher severe rejections. Therefore, it was observed that tissue Doppler was effective in demonstrating diastolic dysfunction in severe rejection.…”

Evaluation of the Role of Conventional and Tissue Doppler Imaging Echocardiography in Detection of Acute Cardiac Allograft Rejection in Heart Transplant Recipients

“…TDI-derived indices have been shown to be useful in predicting subtle cardiac injuries when conventional indices of LV function are still normal. In a study conducted on nearly 400 biopsies using PW-TDI, significant allograft rejection (≥ grade 2) was shown to be associated with a significantly reduced peak early diastolic velocity (Em,) and a significantly prolonged early diastolic time (TEm) of the basal LV inferolateral wall (37). Three smaller studies have also demonstrated that Em significantly reduced in allograft rejection (23,38,39).…”