Skip to main content

Echocardiographic Diagnosis of Acute Allograft Rejection

  • Chapter
Cardiac Allograft Rejection

Abstract

The “gold-standard” for detection of allograft rejection is the right ventricularendomyocardial biopsy, sampled on a regular basis particularly during the first yearafter transplantation. Individual patients routinely have more than 10 biopsies in thefirst year alone. Endomyocardial biopsies are expensive, time-consuming and not 100% sensitive since sampling error may occur. These limitations have createda need for developing an inexpensive, non-invasive methods to assess the entireallograft for rejection and to follow its response to therapy

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Valantine HA, Appleton CA, Hatle L, Hunt SA, Stinson EB, Popp RL: Influence of recipient atrialcontraction on left ventricular filling dynamics of the transplanted heart assessed by Doppler echocardiography. Am J Cardiol 59:1159–63, 1987.

    Article  PubMed  CAS  Google Scholar 

  2. Angermann CE, Spes CH, Tammen A, Stempfle HU, Schutz A, Kemkes BM, Theisen K: Anatomiccharacteristics and valvular function of the transplanted heart: Transthoracic versus transesophagealechocardiographic findings. J Heart Transplant 9:331–8, 1990.

    PubMed  CAS  Google Scholar 

  3. McCarthy PM, Smith JA, Siegel LC, Engstrom RH, Fitzgerald DC, Sarris GE, Stinson EB: Chapter 3, Cardiac Transplant Admission, Anesthesia, and Operative Procedures. In: Smith JA, McCarthy PM, Sarris GE, Stinson EB, Reitz BA. The Stanford Manual of Cardiopulmonary Transplantation.Futura Publishing Company, Armonk, New York, 1996.

    Google Scholar 

  4. Gorcsan II J, Snow FR, Paulsen W, Arrowood JA, Thompson JA, Nixon JV: Echocardiographicprofile of the transplanted human heart in clinically well recipients. J Heart Lung Transplant 11:80–9, 1992.

    PubMed  Google Scholar 

  5. Valantine HA, Oldershaw PJ, Fowler MB, Gibson DG, Hatle L, Hunt, SA, Billingham ME, Stinson EB, Popp RL: Changes in Doppler and M-mode echocardiographic indices of left ventricularfunction during acute cardiac allograft rejection. Br Heart J 57:86, 1987.

    Article  Google Scholar 

  6. McGiffin C, Karp RB, Logic JR, Tauxe WN, Cegallos R: Results of radionuclide assessment ofcardiac function following transplantation of the heart. Ann Thorac Surg 37:382–6, 1984.

    Article  PubMed  CAS  Google Scholar 

  7. Schuler S, Thomas D, Thebken M, Frei U, Wagner T, Warnecke H, Hetzer R: Endocrine response toexercise in cardiac transplant patients. Transplant Proc XIX:2506–9, 1987.

    Google Scholar 

  8. Tischler MD, Lee RT, Plappert T, Mudge GH, S MS, Parker JD: Serial assessment of left ventricular function and mass after orthotopic heart transplantation: A 4-year longitudinal study. J Am CollCardiol 19:60–6, 1992.

    Article  CAS  Google Scholar 

  9. Valantine HA, Hunt SA, Billingham ME, Stinson EB, Popp RL: Increasing pericardial effusion incardiac transplant recipients. Circulation 79:603–9, 1989.

    Article  PubMed  CAS  Google Scholar 

  10. Valantine HA, Appleton CA, Hatle LK, Hunt SA, Billingham ME, Shumway NE, Stinson EB, PoppRL: A hemodynamic and Doppler echocardiographic study of ventricular function in long-termcardiac allograft recipients: Etiology and prognosis of restrictive-constrictive physiology. Circulation 79:66–75, 1989.

    Article  PubMed  CAS  Google Scholar 

  11. Valantine HA, Hatle LK, Appleton CP, Gibbons R, Popp RL: Variability of Doppler echocardiographic indices of left ventricular filling in transplant recipients and normal subjects. J Am SocEchocardiogr 3:276–84, 1990.

    CAS  Google Scholar 

  12. St. Goar FG, Gibbons R, Schnittger I, Valantine HA, Popp L: Left ventricular diastolic function:Doppler echocardiographic changes soon after cardiac transplantation. Circulation 82:872–8, 1990.

    Article  Google Scholar 

  13. Valantine HA, Fowler MB, Hunt SA, Naasz C, Hatle LK, Billingham ME, Stinson EB, Popp RL:Changes in Doppler echocardiographic indices of left ventricular function as potential markers ofacute cardiac rejection. Circulation 76(suppl V):V86–V92, 1987.

    PubMed  CAS  Google Scholar 

  14. Young JB, Leon CA, Short HD II, et al: Evolution of hemodynamics after orthotopic heart andheart/lung transplantation: Early restrictive patterns persisting in occult fashion. J Heart Transplant 6:34–43, 1987.

    PubMed  CAS  Google Scholar 

  15. Parry G, Malbut K, Dark JH, Bexton RS: Differences in left ventricular filling patterns in heart andheart-lung transplant recipients as assessed by Doppler echocardiography of transmitral flow. J HeartLung Transplant 11:875–7, 1992.

    CAS  Google Scholar 

  16. Simmonds MB, Lythall DA, Slorach C, Ilsley CDJ, Mitchell AG, Yacoub MH: Doppler examinationof superior vena caval flow for the detection of acute cardiac rejection. Circulation 86(suppl II):II-259–II-266, 1992.

    Google Scholar 

  17. Caves PK, Stinson EB, Billingham ME, et al: Diagnosis of human allograft rejection by serial cardiacbiopsy. J Thorac Cardiovasc Surg 66:461–6, 1973.

    PubMed  CAS  Google Scholar 

  18. Sagar KB, Hastillo A, Wolfgang TC, Lower RR, Hess ML: Left ventricular mass by M-mode echocar-diography in cardiac transplant patients and acute rejection. Circulation 64(suppl II):216–20, 1981.

    Google Scholar 

  19. Paulsen W, Magid N, Sagar K, Hastillo A, Wolfgang TC, Lower RR, Hess ML: Left ventricularfunction of heart allografts during acute rejection: An echocardiographic assessment. J Heart Transplant 4:525–9, 1985.

    PubMed  CAS  Google Scholar 

  20. Dawkins KD, Oldershaw PJ, Billingham ME, Hunt SA, Oyer PE, Jamieson SW, Popp RL, Stinson EB, Shumway NE: Changes in diastolic function as a non-invasive marker of cardiac allograftrejection. Heart Transplant 3:286–94, 1984.

    Google Scholar 

  21. Wilensky RL, Bourdillon PDV, O’Donnell JA, Sharp SM, Armstrong WF, Fineberg NS, Himes V, Waller BF: Restrictive hemodynamic patterns after cardiac transplantation: Relationship to histological signs of rejection. Am Heart J 122:1079–87, 1991.

    Article  PubMed  CAS  Google Scholar 

  22. Amende I, Simon R, Seegers A, et al: Diastolic dysfunction during acute cardiac allograft rejection.Circulation 81(suppl III):III-60–III-70, 1990.

    Google Scholar 

  23. Gill EA, Borrego C, Bray BE, Renlund DG, Hammond EH, Gilbert EM: Left ventricular massincreases during cardiac allograft vascular rejection. J Am Coll Cardiol 25:922–6, 1995.

    Article  PubMed  CAS  Google Scholar 

  24. McNamara D, DiSalvo T, Mathier M, Vlahakes G, Southern J, Semigran M, Dec GW: Biopsy negative left ventricular dysfunction after cardiac transplantation: Outcome and role of enhanced immunosuppression. J Heart Lung Transplant 14(no. 1, pt. 2):S46, 1995.

    Google Scholar 

  25. Czerska B, Hobbs RE, James KB, Bott-Silverman C, Rincon G, McCarthy PM, Ratliff NV, Stewart RW: Clinical manifestation of acute vascular rejection in cardiac transplant recipients. J Heart LungTransplant 14(no. 1, pt. 2):S46, 1995.

    Google Scholar 

  26. Wiedermann JG, Drusin R, Levin H, Schwartz A, Apfelbaum M: Unexplained heart failure in cardiactransplant recipients: Intracoronary ultrasound identifies two distinct subgroups. J Am Coll Cardiol(special issue):334A, 1995.

    Google Scholar 

  27. Boucek MM, Mathis CM, Boucek Jr. RJ, Hodgkin DD, Kanakriyeh MS, McCormack J, Gundry SR, Bailey LL: Prospective evaluation of echocardiography for primary rejection surveillance after infantheart transplantation: Comparison with endomyocardial biopsy. J Heart Lung Transplant 13:66–73,1994.

    PubMed  CAS  Google Scholar 

  28. Harada K, Reller MD, Shiota T, Marcella CP, Sahn DJ: Echocardiographic indexes of rejection inpediatric cardiac transplant recipients managed without maintenance steroid immunosuppresion. Am J Card 79:693–6, 1997.

    Article  PubMed  CAS  Google Scholar 

  29. Neuberger S, Vincent R, Doelling N, Sullivan K, Honeycutt S, Kantor KR, Fyfe D: Comparison of quantitative echocardiography with endomyocardial biopsy to define myocardial rejection in pediatric patients after cardiac transplantation. Am J Cardiol 79:447–50, 1997.

    Article  PubMed  CAS  Google Scholar 

  30. Upton MT, Gibson DG, Brown DJ: Echocardiographic assessment of abnormal left ventricularrelaxation in man. Br Heart J 38:1001–9, 1976.

    Article  PubMed  CAS  Google Scholar 

  31. Dodd DA, Brady LD, Carden KA, Frist WH, Boucek MM, Boucek Jr. RJ: Pattern of echocardiographic abnormalities with acute cardiac allograft rejection in adults: correlation withendomyocardial biopsy. J Heart Lung Transplant 12:1009–18, 1993.

    PubMed  CAS  Google Scholar 

  32. Mastropolo R, Clark MB, Spotnitz HM, et al: Variation in LV mass in cyclosporine-treated humansafter cardiac transplantation: Determination by two-dimensional echocardiography. Surg Forum 35:371–3, 1985.

    Google Scholar 

  33. Popp RL, Schroeder JS, Stinson EB, Shumway NE, Harrison DE: Ultrasonic studies for the earlydetection of acute cardiac rejection. Transplantation 11:543–50, 1971.

    PubMed  CAS  Google Scholar 

  34. Stempfle HU, Strom C, Spes C, Uberfuhr P, Kruger TM, Reichart B, Theisen K, Angermann CE:Intramyocardial electrograms for monitoring allograft rejection after heart transplantation. Transp Pro 27:1981–2, 1995.

    CAS  Google Scholar 

  35. Boucek MM: Echocardiographic evaluation in pediatric heart transplantation: A platinum standard? J Heart Lung Transplant 10:842–4, 1991.

    Google Scholar 

  36. Sagar KB, Hastillo A, Wolfgang TC, Lower RR, Hess ML: Left ventricular mass by M-mode echocardiography in cardiac transplant patients and acute rejection. Circulation 64(suppl II):216–20, 1981.

    Google Scholar 

  37. Fauchier L, Sirinelli A, Aupart M, Babuty D, Marchand M, Pottier JM: Performances of dopplerechocardiography for diagnosis of acute mild, or moderate cardiac allograft rejection. Transp Pro 29:2442–5, 1997.

    Article  CAS  Google Scholar 

  38. Dubroff JM, Clark MB, Wong CYH, et al: Changes in left ventricular mass associated with the onsetof acute rejection after cardiac transplantation. Heart Transplant 3:105–9, 1984.

    Google Scholar 

  39. Clark MB, Spotnitz HM, Dubroff JM, et al: Acute rejection after cardiac transplantation: Detectionby two-dimensional echocardiography. Surg Forum 34:248–50, 1983.

    Google Scholar 

  40. Vanderberg BF, Mohanty PK, Craddock KJ, et al: Clinical significance of pericardial effusion afterheart transplantation. J Heart Transplant 7:128–34, 1988.

    Google Scholar 

  41. Cilberto GR, Anjos MC, Gronda E, et al: Significance of pericardial effusion after hearttransplantation. Am J Cardiol 76:297–300, 1995.

    Article  Google Scholar 

  42. Popp RL: Recent experience with ultrasonic tissue characterization. Am J Cardiol 69:112H–116H, 1992.

    Article  PubMed  CAS  Google Scholar 

  43. Skorton DJ, Miller JG, Wichline SA, Barzullai B, Collins SM, Perez JE: Ultrasonic characterizationof cardiovascular tissue. In: Marcus ML, Schelbert HR, Skorton DJ, Wolt GL (eds). Cardiac Imaging. Philadelphia: Saunders, 1991, pp. 538–56.

    Google Scholar 

  44. Stempfle H-U, Angermann CE, Kraml P, Schutz A, Kemkes BM, Theisen K: Serial changes duringacute cardiac allograft rejection: Quantitative ultrasound tissue analysis versus myocardial histologicfindings. J Am Coll Cardiol 22:310–17, 1993.

    Article  PubMed  CAS  Google Scholar 

  45. Masuyama T, Valantine HA, Gibbons R, Schnittger I, Popp RL: Serial measurement of integratedbackscatter in human cardiac allografts for the recognition of acute rejection. Circulation 81:829–39,1990.

    Article  PubMed  CAS  Google Scholar 

  46. Angermann CE, Nassau K, Drewello R, Kruger TM, Junge R, Uberfuhr P, Stempfle H-U: Time averaged myocardial integrated backscatter measurements allow to identify and estimate severity of acute allograft rejection after transplantation in man. Circulation 90:1–326, 1994.

    Article  Google Scholar 

  47. Dawkins K, Haverich A, Salim A, Billingham ME, Jamieson SW, Gibson DG: Detection of acutecardiac rejection using color echocardiography. Circulation 72(suppl II):III-207, 1985.

    Google Scholar 

  48. Angermann CE, Nassau K, Stempfle HU, Kruger TM, Drewello R, Junge R, Uberfuhr P, Weib M,Theisen K: Recognition of acute cardaic allograft rejection from serial integrated backscatter analyses in human orthotopic heart transplant recipients. Circulation 95:140–50, 1997.

    Article  PubMed  CAS  Google Scholar 

  49. Gotteiner NL, Vonesh MJ, Crawford SE, Burns WR, Duffy E, Zales VR, McPherson DD:Myocardial acoustics in pediatric allograft rejection. J Heart Lung Transplant 15:596–604, 1996.

    PubMed  CAS  Google Scholar 

  50. Appleton CP, Hatle LK, Popp RL: Demonstration of restrictive ventricular physiology by Dopplerechocardiography. J Am Coll Cardiol 11:757–68, 1988.

    Article  PubMed  CAS  Google Scholar 

  51. Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Auinones MA: Determination of parameters of leftventricular diastolic filling with pulsed Doppler echocardiography: Comparison with angiography.Circulation 71:543, 1985.

    Article  PubMed  CAS  Google Scholar 

  52. Spirito P, Maron BJ, Bonow RO: Noninvasive assessment of left ventricular diastolic function: Comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques. J Am CollCardiol 7:518, 1986.

    Article  CAS  Google Scholar 

  53. Valantine HA, Fowler M, Hatle L, Hunt S, Billingham ME, Stinson EB, Popp RL: Doppler echocardiographic indices of diastolic function as markers of acute cardiac rejection. Transplant Proc 19:2556–9, 1987.

    PubMed  CAS  Google Scholar 

  54. Valantine HA, Yeoh TK, Gibbons R, McCarthy P, Stinson EB, Billingham ME, Popp RL: Sensitivity and specificity of diastolic indexes for rejection and surveillance: temporal correlationwith endomyocardial biopsy. J Heart Lung Transplant 10:757–65, 1991.

    PubMed  CAS  Google Scholar 

  55. Desruennes M, Corcos T, Cabrol A, Gandjbakhch I, Pavie A, Leger P, Eugene M, Bors V, Cabrol C:Doppler echocardiography for the diagnosis of acute allograft rejection. J Am Coll Cardiol 12:63–70, 1988.

    Article  PubMed  CAS  Google Scholar 

  56. Furniss SS, Murray A, Hunter S, Dougenis V, McGregor CG: Value of echocardiography determination of isovolumic relaxation time in the detection of heart transplant rejection. J Heart LungTransplant 10:557–61, 1991.

    CAS  Google Scholar 

  57. Pellicelli AM, Cosial JB, Ferranti E, Gomez A, Borgia MC: Alteration of left ventricular fillingevaluated by doppler echocardiography as a potential marker of acute rejection in orthotopic hearttransplant: Angiology, The Journal of Vase Dis 47:35–41, 1996.

    CAS  Google Scholar 

  58. Boyd SYN, Mego DM, Khan NA, Rubal BJ, Gilbert TM: Doppler echocardiography in cardiac trans-plant patients: Allograft rejection and its relationship to diastolic function. J Am Soc Echocardiogr 10:526–31, 1997.

    Article  PubMed  CAS  Google Scholar 

  59. McAllister HA, Schnee MJM, Radovancevic B, Frazier OH: Transplantation. A system for gradingallograft rejection. Texas Heart Institute J 13:1–3, 1986.

    Google Scholar 

  60. Pai RG, Suzuki M, Heywood T, Ferry DR, Shah PM: Mitral A velocity wave transit time to theoutflow tract as a measure of left ventricular diastolic stiffness. Hemodynamic correlations in patientswith coronary artery disease. Circulation 89:553–7, 1994.

    Article  PubMed  CAS  Google Scholar 

  61. Puleo JA, Aranda JM, Weston MW, Cintron G, French M, Clark L, Fontanet HL: Noninvasive detec-tion of allograft rejection in heart transplant recipients by use of Doppler tissue imaging. J HeartLung Transplantation 17:176–84, 1998.

    CAS  Google Scholar 

  62. Ciliberto GR, Mascarello M, Gronda E, Bonacina E, Anjos MC, Danzi G, Colombo P, Frigerio M, Alberti A, DeVita C: Acute rejection after heart transplantation: Noninvasive echocardiographicevaluation. J Am Coll Cardiol 23:1156–60, 1994.

    Article  PubMed  CAS  Google Scholar 

  63. Rizeq MN, Masek MA, Billingham ME: Acute rejection: Significance of elapsed time aftertransplantation. J Heart Lung Transplant 13:862–8, 1994.

    PubMed  CAS  Google Scholar 

  64. Forster T, McGhie J, Rijsterborgh H, et al: Can we assess the changes of ventricular filling resultingfrom acute allograft rejection with Doppler echocardiography? J Heart Transplant 7:430–4, 1988.

    PubMed  CAS  Google Scholar 

  65. Yeoh T-K, Frist WH, Eastburn TE, Atkinson J: Clinical significance of mild rejection of the cardiacallograft. Circulation 86(suppl II):II-267–II-271, 1992.

    Google Scholar 

  66. Gopal AS, Schnellbaecher MJ, Shen Z, Akinboboye OO, Sapin PM, King DL: Freehand three-dimensional echocardiography for measurement of left ventricular mass: in vivo anatomic validationusing explanted human hearts. J Am Coll Cardiol 30:802–10, 1997.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Giannetti, N., Valantine, H.A. (2001). Echocardiographic Diagnosis of Acute Allograft Rejection. In: Dec, G.W., Narula, J., Ballester, M., Carrio, I. (eds) Cardiac Allograft Rejection. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1649-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-1649-1_14

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5659-2

  • Online ISBN: 978-1-4615-1649-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics