Detection of Biopsy Negative Hemodynamically Significant Heart Transplant Rejection by Doppler Tissue Imaging

Abstract

614 Doppler Tissue Imaging (DTI) has been shown to be a reliable, noninvasive technique for the detection of cellular rejection in heart transplant recipients. Rejection with hemodynamic compromise, although rare, represents a major complication of heart transplantation with a poor long-term outcome. Survivors of hemodynamically compromising rejection episodes associated with low biopsy scores have a significantly worse long term outcome than survivors of episodes with a high score. Immunologic mechanisms other than lymphocytic infiltration of the cardiac allograft is felt to be the cause of the allograft dysfunction. The aim of this study is to examine the accuracy of DTI in the detection of hemodynamically significant biopsy negative rejection. Methods: Over a two year period, a total of 605 biopsies were performed on 120 heart transplant recipients. DTI was performed concurrently. Seven episodes of biopsy negative hemodynamically significant rejection, defined as EF<30%, S3 gallop, inotropic support, CI≤2.0, or PCW≥20 mmHg occurred during this time. All biopsies were Grade O or IA. After treatment, repeat biopsies and DTI's were performed. Rejection by DTI was defined as an E-wave velocity ≤ 0.16 m/sec and/or ≥20% decrease from the previous value. Results: Table There was a significant drop in E-wave velocity with biopsy negative hemodynamically significant rejection(p<0.05) with return to baseline after therapy (p<0.05).Conclusion: DTI (E-wave velocity) is useful in the detection of hemodynamically significant biopsy negative rejection.