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. 2001 Oct;86(4):432–437. doi: 10.1136/heart.86.4.432

Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection

S Stengel 1, Y Allemann 1, M Zimmerli 1, E Lipp 1, N Kucher 1, P Mohacsi 1, C Seiler 1
PMCID: PMC1729918  PMID: 11559685

Abstract

OBJECTIVE—To test the hypothesis that diastolic mitral annular motion velocity, as determined by Doppler tissue imaging and left ventricular diastolic flow propagation velocity, is related to the histological degree of heart transplant rejection according to the International Society of Heart and Lung Transplantation (ISHLT).
METHODS—In 41 heart transplant recipients undergoing 151 myocardial biopsies, the following Doppler echocardiographic measurements were performed within one hour of biopsy: transmitral and pulmonary vein flow indices; mitral annular motion velocity indices; left ventricular diastolic flow propagation velocity.
RESULTS—Late diastolic mitral annular motion velocity (ADTI) and mitral annular systolic contraction velocity (SCDTI) were higher in patients with ISHLT < IIIA than in those with ISHLT ⩾ IIIA (ADTI, 8.8 cm/s v 7.7 cm/s (p = 0.03); SCDTI, 19.3 cm/s v 9.3 cm/s (p < 0.05)). Sensitivity and specificity of ADTI < 8.7 cm/s (the best cut off value) in predicting significant heart transplant rejection were 82% and 53%, respectively. Early diastolic mitral annular motion velocity (EDTI) and flow propagation velocity were not related to the histological degree of heart transplant rejection.
CONCLUSIONS—Doppler tissue imaging of the mitral annulus is useful in diagnosing heart transplant rejection because a high late diastolic mitral annular motion velocity can reliably exclude severe rejection. However, a reduced late diastolic mitral annular motion velocity cannot predict severe rejection reliably because it is not specific enough.


Keywords: heart transplant rejection; diastolic function; Doppler tissue imaging; echocardiography

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Figure 1  .

Figure 1  

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Doppler tissue imaging derived mitral annular motion velocity profiles obtained from the apical two chamber view from a heart transplant recipient. The following diastolic annular motion variables were measured: early (EDTI) and late (ADTI) diastolic mitral annular motion velocity; deceleration time of EDTI (E-decDTI); duration of late mitral annular motion velocity (A-durDTI); mitral annular isovolumetric relaxation time (IVRTDTI); mitral annular systolic contraction velocity (SCDTI); and mitral annular systolic contraction time (SCTDTI).

Figure 2  .

Figure 2  

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Measurement from colour Doppler M mode of left ventricular diastolic flow propagation velocity, which is determined by the slope of the first aliasing isovelocity line during early ventricular filling. The velocity is assessed from the apical four chamber view at 4 cm distal to the mitral valve plane (0.051 s for 4.02 cm is equal to a flow propagation velocity of 78.6 cm/s).

Figure 3  .

Figure 3  

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Changes in late diastolic mitral annular motion velocity (ADTI, cm/s, vertical axis) among patients without (ISHLT < IIIA) and with (ISHLT ⩾ IIIA) severe heart transplant rejection. ADTI ⩾ 8.7 cm/s can reliably exclude severe heart transplant rejection, but a reduced ADTI cannot predict severe rejection.

Selected References

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