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Updated: Jun 1, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Tissue doppler echocardiography in the diagnosis of heart transplantation rejection
Marcos Valério Coimbra Resende1, Marcelo Luiz Campos Vieira, Fernando Bacal
1Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, SP, Brazil. mlvieira@cardiol.br
Insights
Tissue Doppler imaging (TDI) shows promise in detecting cellular rejection (CR) after heart transplantation (HT), offering valuable diagnostic information beyond conventional Doppler methods.
Area of Science:
- Cardiology
- Transplant Medicine
- Diagnostic Imaging
Background:
- Endomyocardial biopsy (EMB) is the gold standard for diagnosing cellular rejection (CR) post-heart transplantation (HT).
- Accurate and timely CR detection is crucial for graft survival.
Purpose of the Study:
- To evaluate if tissue Doppler imaging (TDI) can detect significant cellular rejection (CR > 3A) after heart transplantation.
- To determine if TDI provides additional diagnostic information compared to conventional Doppler echocardiography.
Main Methods:
- Fifty-four heart transplant patients underwent 129 EMB and TDI echocardiography within 24 hours.
- TDI parameters including systolic (S), early diastolic (e'), and late diastolic (a') velocities were measured in various cardiac segments.
- Patients were categorized into CR > 3A and CR < 3A groups, with a normal control group for comparison.
Main Results:
- Cellular rejection (CR > 3A) was identified in 30.2% of endomyocardial biopsies.
- Late diastolic velocity in the lateral wall (a'LAT) was the best single predictor of CR (sensitivity 76.3%, specificity 73.8%).
- A multivariate model incorporating TDI parameters achieved 88.2% sensitivity and 79.6% accuracy for diagnosing CR > 3A, outperforming conventional Doppler.
Conclusions:
- Tissue Doppler imaging (TDI) provides significant diagnostic information for detecting cellular rejection (CR > 3A) after heart transplantation.
- A TDI-based scoring system shows potential as a non-invasive method for monitoring CR post-transplant.
Background:
Endomyocardial biopsy (EMB) is the gold standard method for the diagnosis of cellular rejection (CR) after heart transplantation (HT).
Objective:
To test the hypothesis that tissue Doppler imaging (TDI) could detect CR > 3A and add diagnostic information compared to conventional Doppler.
Methods:
Fifty-four HT patients underwent 129 EMB and a TDI echocardiographic study within 24 hours. We compared HT patients with CR > 3A versus HT patients with CR < 3A, with a normal matched control group (13 patients). We measured TDI systolic (S), early diastolic (e'), late diastolic (a') velocities and e'/a' ratio in the left ventricular annulus, basal and medium (mid) segments of the septal (SEP), lateral (LAT), inferior (INF), anterior (ANT) walls; and in the right ventricular annulus.
Results:
HT patients showed CR > 3A in 39/129 (30.2%) EMB. The best isolated predictor for CR diagnosis was a'LAT, with a sensitivity of 76.3%, specificity of 73.8% (p = 0.001). In the multivariate analysis, a'LAT (p = 0.001), a'SEP (p = 0.002), e'/a' LAT ratio (p = 0.006), e'Mitral/ e'LAT ratio (p = 0.014), SINF (p = 0.009) predicted CR > 3A. We obtained a score with a sensitivity of 88.2%, accuracy of 79.6% and negative predictive value of 92.9% to diagnose CR > 3A. Conventional Doppler (mitral and pulmonary venous flow) was not relevant to predict CR > 3A.
Conclusion:
TDI added diagnostic information to predict CR > 3A compared to conventional Doppler. A TDI-based model could become a potential method to detect CR > 3A after heart transplantation.
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