Acute rejection after heart transplantation: Noninvasive echocardiographic evaluation

Guglielma Rita Ciliberto, Margherita Mascarello, Edoardo Gronda, Edgardo Bonacina, Maria Clemencia Anjos, Gianbattista Danzi, Paola Colombo, Maria Frigerio, Antonia Alberti, Claudio De Vita

Research output: Contribution to journalArticle

Abstract

Objectives. The purpose of this study was to assess the reliability of echocardiography in the noninvasive diagnosis of acute rejection in heart transplant recipients. Background. Although echocardiographic results seem to correlate well with allograft rejection, published data are limited and contradictory. Methods. In 130 transplant recipients, 1,400 serial echocardiograms were recorded within 24 h of endomyocardial biopsy. Increased wall thickness, myocardial echogenicity, pericardial effusion, shorter pressure half-time, isovolumetric relaxation time and a decrease in left ventricular ejection fraction were considered markers of rejection. Results. The distribution of echocardiographic markers revealed highly significant differences between bioptically graded moderate, mild and no rejection and between untreated and treated rejection episodes (both chi-square test, p <0.0001). Specificity was 98.6% for two markers, but sensitivity was good (80%) for only moderate rejection because of the large number of false negatives in untreated patients with mild rejection. In untreated patients, there was a highly significant difference in the number of echocardiographic criteria between a benign and nonbenign outcome (chi-square test, p <0.0001). In treated patients, the significant difference in the variation in echocardiographic criteria between favorable and unfavorable responses after 1 week was more pronounced after 2 weeks (t test, p <0.01 vs. <0.081). Diastolic indexes and pericardial effusion at 2 weeks seemed to be predictive of therapeutic response. Conclusions. Poor sensitivity to mild rejection indicates that serial echocandiography cannot supplant endomyocardial biopsy in the early diagnosis of acute rejection, but it seems to be a reliable noninvasive means of identifying acute rejection requiring intensified immunosuppressive therapy and of evaluating outcome.

Original languageEnglish
Pages (from-to)1156-1161
Number of pages6
JournalJournal of the American College of Cardiology
Volume23
Issue number5
DOIs
Publication statusPublished - 1994

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Heart Transplantation
Pericardial Effusion
Chi-Square Distribution
Biopsy
Immunosuppressive Agents
Stroke Volume
Allografts
Echocardiography
Early Diagnosis
Pressure
Therapeutics
Transplant Recipients

ASJC Scopus subject areas

  • Nursing(all)

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Acute rejection after heart transplantation : Noninvasive echocardiographic evaluation. / Ciliberto, Guglielma Rita; Mascarello, Margherita; Gronda, Edoardo; Bonacina, Edgardo; Anjos, Maria Clemencia; Danzi, Gianbattista; Colombo, Paola; Frigerio, Maria; Alberti, Antonia; De Vita, Claudio.

In: Journal of the American College of Cardiology, Vol. 23, No. 5, 1994, p. 1156-1161.

Research output: Contribution to journalArticle

Ciliberto, GR, Mascarello, M, Gronda, E, Bonacina, E, Anjos, MC, Danzi, G, Colombo, P, Frigerio, M, Alberti, A & De Vita, C 1994, 'Acute rejection after heart transplantation: Noninvasive echocardiographic evaluation', Journal of the American College of Cardiology, vol. 23, no. 5, pp. 1156-1161. https://doi.org/10.1016/0735-1097(94)90605-X
Ciliberto, Guglielma Rita ; Mascarello, Margherita ; Gronda, Edoardo ; Bonacina, Edgardo ; Anjos, Maria Clemencia ; Danzi, Gianbattista ; Colombo, Paola ; Frigerio, Maria ; Alberti, Antonia ; De Vita, Claudio. / Acute rejection after heart transplantation : Noninvasive echocardiographic evaluation. In: Journal of the American College of Cardiology. 1994 ; Vol. 23, No. 5. pp. 1156-1161.
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abstract = "Objectives. The purpose of this study was to assess the reliability of echocardiography in the noninvasive diagnosis of acute rejection in heart transplant recipients. Background. Although echocardiographic results seem to correlate well with allograft rejection, published data are limited and contradictory. Methods. In 130 transplant recipients, 1,400 serial echocardiograms were recorded within 24 h of endomyocardial biopsy. Increased wall thickness, myocardial echogenicity, pericardial effusion, shorter pressure half-time, isovolumetric relaxation time and a decrease in left ventricular ejection fraction were considered markers of rejection. Results. The distribution of echocardiographic markers revealed highly significant differences between bioptically graded moderate, mild and no rejection and between untreated and treated rejection episodes (both chi-square test, p <0.0001). Specificity was 98.6{\%} for two markers, but sensitivity was good (80{\%}) for only moderate rejection because of the large number of false negatives in untreated patients with mild rejection. In untreated patients, there was a highly significant difference in the number of echocardiographic criteria between a benign and nonbenign outcome (chi-square test, p <0.0001). In treated patients, the significant difference in the variation in echocardiographic criteria between favorable and unfavorable responses after 1 week was more pronounced after 2 weeks (t test, p <0.01 vs. <0.081). Diastolic indexes and pericardial effusion at 2 weeks seemed to be predictive of therapeutic response. Conclusions. Poor sensitivity to mild rejection indicates that serial echocandiography cannot supplant endomyocardial biopsy in the early diagnosis of acute rejection, but it seems to be a reliable noninvasive means of identifying acute rejection requiring intensified immunosuppressive therapy and of evaluating outcome.",
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T1 - Acute rejection after heart transplantation

T2 - Noninvasive echocardiographic evaluation

AU - Ciliberto, Guglielma Rita

AU - Mascarello, Margherita

AU - Gronda, Edoardo

AU - Bonacina, Edgardo

AU - Anjos, Maria Clemencia

AU - Danzi, Gianbattista

AU - Colombo, Paola

AU - Frigerio, Maria

AU - Alberti, Antonia

AU - De Vita, Claudio

PY - 1994

Y1 - 1994

N2 - Objectives. The purpose of this study was to assess the reliability of echocardiography in the noninvasive diagnosis of acute rejection in heart transplant recipients. Background. Although echocardiographic results seem to correlate well with allograft rejection, published data are limited and contradictory. Methods. In 130 transplant recipients, 1,400 serial echocardiograms were recorded within 24 h of endomyocardial biopsy. Increased wall thickness, myocardial echogenicity, pericardial effusion, shorter pressure half-time, isovolumetric relaxation time and a decrease in left ventricular ejection fraction were considered markers of rejection. Results. The distribution of echocardiographic markers revealed highly significant differences between bioptically graded moderate, mild and no rejection and between untreated and treated rejection episodes (both chi-square test, p <0.0001). Specificity was 98.6% for two markers, but sensitivity was good (80%) for only moderate rejection because of the large number of false negatives in untreated patients with mild rejection. In untreated patients, there was a highly significant difference in the number of echocardiographic criteria between a benign and nonbenign outcome (chi-square test, p <0.0001). In treated patients, the significant difference in the variation in echocardiographic criteria between favorable and unfavorable responses after 1 week was more pronounced after 2 weeks (t test, p <0.01 vs. <0.081). Diastolic indexes and pericardial effusion at 2 weeks seemed to be predictive of therapeutic response. Conclusions. Poor sensitivity to mild rejection indicates that serial echocandiography cannot supplant endomyocardial biopsy in the early diagnosis of acute rejection, but it seems to be a reliable noninvasive means of identifying acute rejection requiring intensified immunosuppressive therapy and of evaluating outcome.

AB - Objectives. The purpose of this study was to assess the reliability of echocardiography in the noninvasive diagnosis of acute rejection in heart transplant recipients. Background. Although echocardiographic results seem to correlate well with allograft rejection, published data are limited and contradictory. Methods. In 130 transplant recipients, 1,400 serial echocardiograms were recorded within 24 h of endomyocardial biopsy. Increased wall thickness, myocardial echogenicity, pericardial effusion, shorter pressure half-time, isovolumetric relaxation time and a decrease in left ventricular ejection fraction were considered markers of rejection. Results. The distribution of echocardiographic markers revealed highly significant differences between bioptically graded moderate, mild and no rejection and between untreated and treated rejection episodes (both chi-square test, p <0.0001). Specificity was 98.6% for two markers, but sensitivity was good (80%) for only moderate rejection because of the large number of false negatives in untreated patients with mild rejection. In untreated patients, there was a highly significant difference in the number of echocardiographic criteria between a benign and nonbenign outcome (chi-square test, p <0.0001). In treated patients, the significant difference in the variation in echocardiographic criteria between favorable and unfavorable responses after 1 week was more pronounced after 2 weeks (t test, p <0.01 vs. <0.081). Diastolic indexes and pericardial effusion at 2 weeks seemed to be predictive of therapeutic response. Conclusions. Poor sensitivity to mild rejection indicates that serial echocandiography cannot supplant endomyocardial biopsy in the early diagnosis of acute rejection, but it seems to be a reliable noninvasive means of identifying acute rejection requiring intensified immunosuppressive therapy and of evaluating outcome.

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