The role of left and right ventricular early diastolic Doppler tissue echocardiographic indices in the evaluation of acute rejection in orthotopic heart transplant

Background: The aim was to evaluate whether Doppler tissue echocardiographic early diastolic indices of both the right and left ventricle (LV) may assist in the detection of acute heart transplant (HT) rejection. Methods: in all, 44 consecutive patients with HT (mean age 52.0 +/- 9.6 years, 39 men) were divided into group 1 with no rejection (histopathology grade less than or equal to 2) and group 2 with acute (severe) rejection (grade greater than or equal to 3A). In group 2, echocardiographic examinations were performed before (A), during (B), and after (C) acute rejection. Results: Although patients with HT in group 2B compared with group 1 had lower early diastolic velocities at medial/septal (E-Med) and tricuspid/lateral (E-Tric) annulus, as a result of substantial data overlapping this finding did not allow for the detection of patients with acute rejection. In group 213, both onsets of E-Med and E-Tric were delayed and LV early diastolic mitral/lateral annulus velocities (E-Mitr) markedly preceded E-Tric (E-Tric-E-mitr 68 +/- 45 milliseconds for group 2B vs 7 +/- 43 milliseconds for group 1 and 14 +/- 40 milliseconds for group 2A; P <.01). Additionally, patients with HT in group 2B had pathologically positive late isovolumic relaxation myocardial velocity gradient of LV posterior wall compared with group 1 or group 2A (1.5 +/- 1.4 s(-1) vs -0.3 +/- 2.0 s(-1) or 0.3 +/- 1.8, respectively; P < .01). Late isovolumic relaxation myocardial velocity gradient greater than 0.1 s(-1) and timing differences between onsets of: (1) mitral early diastolic velocity (E wave) and E-Med greater than -35 milliseconds; and (2) E-Tric-E-Mitr greater than 15 milliseconds allowed for the distinction of patients with acute HT rejection (group 2B vs 1) with sensitivity and specificity greater than 0.80. Conclusions: For patients with HT and acute rejection abnormal Doppler tissue echocardiographic indices may be caused by both: (1) altered early diastolic untwist of the oblique LV fibers; and (2) the delay in early diastolic right ventricular relaxation. Late isovolumic relaxation myocardial velocity gradient and early diastolic timing intervals (mitral E wave-E-Med and E-Tric-E-Mitr) are promising new echocardiographic markers that can be used in the surveillance for acute rejection in patients with HT.