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Have we Found a Reliable Non-Invasive
Method to Predict or not, Severe Rejection
in Heart-Transplant Recipients?
Villarraga, Héctor R.; Daza, Héctor;
Sánchez, Jairo; Badiel, Marisol;
Rosso, Fernando; Olaya, Pastor
Echocardiographic and Hemodinamic Laboratory.
Fundación Valle del Lili, Cali, Colombia.
Background: Differents methods have been used to evaluate in a non-invasive manner cardiac rejection after transplantation. Systolic and diastolic parameters have been utilized but the results are misleading. The role of Em and Am of the mitral annulus in the prediction of rejection in heart -transplant recipients has no been established.
Objectives : We sought to evaluate the pattern of the mitral annulus in transplant recipients with (group 1) and without severe rejection (group 2).
Methods: Between November / 1997 and August / 2000, 40 measurements were made within 6 hours from endomyocardial biopsy. Measurements were obtained in 2 machines Acuson Sequoia and 128 XP, peak velocities of the waves Em and Am at the lateral mitral annulus were measured in apical 4 view with a 1 mm sample volume, filters and gains were adjusted these were compared to the histologist results. Hemodynamic parameters were determined.
Results : We obtained velocities in 24 patients, 23 men. The average Ea, Aa and Ea/Aa in group 1 were 1.6, 1.0 and 1.6 respectively and in group 2 1.17, 1.0 and 1.17. A value Em/Am or of Em greater than 1.17 was useful to rule out the presence of severe rejection with specifity 97% (CI95%82-100), negative predictive value of 94 % (CI 95% 78-99 ), sensitivity 50% (9.2-90), and positive predictive value 67%(12.5-98).
Conclusions: A profile of diastolic velocities from mitral annulus with Em/Am or greater than 1.17 allows to rule out the presence of severe acute cardiac rejection in a non-invasive manner with a low rate of false negatives.
2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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