Table 7.

Methods of cardiac allograft rejection monitoring

Method	Delay	Serial assessment	Costs	Indication of rejection	Sensitivity	Specificity
History	None	Yes	+	Dyspnoea, weight gain, discomfort	+	+
Physical exam	None	Yes	+	Arrhythmia, S3, crackles, JVD, oedema	+	+
ECG	None	Yes	+	Atrial arrhythmias, low voltage	+	+
Pacemaker	Telemetry	Every night	+++	Voltage ↓ 7%	+++	+++
Echo	30 mins	Yes	+++	Isovolumic relaxation time ↓, fractional shortening ↓	+++	+++
Biopsy	24 hours	Max 1/week	+++	Cell infiltrates, haemorrhage	+++	+++
Myosin scan	24 hours	Max 1/3 month	+++	Heart/lung ratio >1.6	+++	+++
MRI	1 hour	Max 1/week	+++	Signal ↑ due to oedema	+++	+++
Immune monitoring	4 hours	Yes	+++	CD4/CD8↑, HLA-DR+/CD14 ↑, IL2↑	+++	+++

JVD, jugular venous distension.