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Prediction of acute cardiac rejection by changes in left ventricular volumes
D Novitzky1, D K Cooper, J Boniaszczuk
1Department of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa.
Insights
Radionuclide scanning effectively monitors heart transplant rejection. Changes in stroke and end-diastolic volume detected by scanning strongly correlate with acute rejection identified via endomyocardial biopsy.
Area of Science:
- Cardiology
- Nuclear Medicine
- Transplant Surgery
Background:
- Acute rejection is a significant complication following heart transplantation.
- Accurate and timely monitoring of acute rejection is crucial for patient outcomes.
- Current monitoring methods, like endomyocardial biopsy, can be invasive.
Purpose of the Study:
- To evaluate the utility of multigated equilibrium blood pool scanning as a noninvasive tool for monitoring acute heart transplant rejection.
- To correlate findings from radionuclide scans with endomyocardial biopsy results.
Main Methods:
- Sixteen heart transplant recipients (11 orthotopic, 5 heterotopic) were monitored.
- Acute rejection was assessed using both endomyocardial biopsy (EMB) and technetium 99m-labelled red blood cell scans.
- Radionuclide scans provided data on left ventricular volumes, ejection fraction, and heart rate.
Main Results:
- A significant correlation was observed between reduced stroke volume and end-diastolic volume and the presence of acute rejection on EMB.
- No significant correlation was found between heart rate or ejection fraction and acute rejection.
- Combining stroke volume and end-diastolic volume changes demonstrated 85% sensitivity and 96% specificity for detecting acute rejection compared to EMB.
Conclusions:
- Multigated equilibrium blood pool scanning is a valuable noninvasive method for monitoring acute rejection after heart transplantation.
- Radionuclide scanning can complement or potentially reduce the need for invasive biopsies in rejection surveillance.
- This technique offers a sensitive and specific approach to assessing cardiac allograft status.
Abstract:
Sixteen patients underwent heart transplantation (11 orthotopic, five heterotopic). Monitoring for acute rejection was by both endomyocardial biopsy (EMB) and multigated equilibrium blood pool scanning with technetium 99m-labelled red blood cells. From the scans information was obtained on left ventricular volumes (stroke, end-diastolic, and end-systolic), ejection fraction, and heart rate. Studies (208) were made in the 16 patients. There was a highly significant correlation between the reduction in stroke volume and end-diastolic volume (and a less significant correlation in end-systolic volume) and increasing acute rejection seen on EMB. Heart rate and ejection fraction did not correlate with the development of acute rejection. Correlation of a combination of changes in stroke volume and end-diastolic volume with EMB showed a sensitivity of 85% and a specificity of 96%. Radionuclide scanning is therefore a useful noninvasive tool for monitoring acute rejection.