End of an Era: Reduced Severity of Tricuspid Regurgitation in Cardiac Transplant Recipients Managed with Molecular Diagnostic Testing

Abstract

Purpose A well-established complication of right ventricular endomyocardial biopsy (EMB) used for the diagnosis of acute cellular rejection is damage to the tricuspid valve and subsequent tricuspid regurgitant flow. Since the advent of Molecular Diagnostic Testing (MDT) as a screening test for determining which patients require EMB, the need for EMB at our center has decreased significantly. We hypothesized that the severity of tricuspid regurgitation (TR) should therefore be reduced with greater reliance on MDT and reduced utilization of EMB. Methods and Materials 58 echocardiograms from cardiac transplant patients who survived at least two years post-transplant were reviewed by observers blinded to post-transplant rejection surveillance strategies. 30 patients were in the pre-MDT group, from 2002-2004, when only EMB was used for post-transplant rejection surveillance. 28 patients were in the MDT group, from 2008-2010, when MDT was used as a screen to determine if EMB was required. TR was graded on a scale of zero to four, with zero representing no regurgitation present on echocardiography, one representing trace, two representing mild, three representing moderate and four representing severe TR. Results Of the 30 patients evaluated from the pre-MDT group, from 2002-2004, the average TR score was 1.87. In the 28 patients evaluated after routine MDT testing was implemented, from 2008-2010, the average score was 1.30, indicating a statistically significant reduction in tricuspid regurgitation severity(p = 0.0297). There was no evidence of severe TR in the MDT patients. Conclusions Our findings demonstrate that with greater use of MDT, the severity of tricuspid regurgitation has been reduced. MDT has become an established method for monitoring immune activation and as a screen for identifying the need for EMB in low risk cardiac transplant recipients. Our findings further support the continued use of MDT as a screening test before resorting to EMB.