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Left ventricular function of heart allografts during acute rejection: an echocardiographic assessment
Insights
Acute heart allograft rejection impairs diastolic function, increasing left ventricular thickness and mass. Systolic function remains unaffected, indicating diastolic dynamics are key indicators of rejection.
Area of Science:
- Cardiology
- Transplantation Immunology
- Medical Imaging
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- Acute rejection remains a significant complication, potentially affecting cardiac function.
- Echocardiography is a non-invasive tool for assessing cardiac performance.
Purpose of the Study:
- To evaluate left ventricular (LV) function during acute rejection of heart allografts.
- To compare LV function in rejection, non-rejection, and normal states.
- To identify specific echocardiographic parameters indicative of acute rejection.
Main Methods:
- Computer-assisted analysis of echocardiograms in 9 heart allograft recipients.
- Comparison of LV function during biopsy-proven acute rejection versus non-rejection states.
- Comparison with LV function data from 10 healthy normal subjects.
Main Results:
- Non-rejecting allografts showed normal LV dimensions and function, similar to controls.
- Acute rejection was linked to increased LV mural thickness and mass.
- Diastolic dysfunction was evident during rejection, with prolonged rapid filling and reduced lengthening/thinning rates (p < 0.05).
- Systolic function parameters (fractional shortening, peak shortening/thinning rates) were not significantly altered by rejection.
Conclusions:
- Left ventricular function in non-rejecting heart allografts is comparable to normal individuals.
- Acute rejection significantly impacts LV diastolic dynamics, characterized by specific abnormalities.
- Systolic function remains preserved during acute rejection, suggesting diastolic changes are primary indicators.
Abstract:
Left ventricular function was evaluated in nine patients during biopsy proven acute rejection of heart allografts using computer-assisted analysis of echocardiograms. The results were compared with data obtained during their non-rejection state and with data obtained from 10 normal subjects. Left ventricular dimensions and parameters of diastolic and systolic function of non-rejecting hearts were similar to those of normals. Acute rejection was associated with increased left ventricular mural thickness and mass, and abnormal diastolic function characterized by a prolongation of the rapid filling period from 155 msec +/- 14 msec to 183 msec +/- 16 msec (p less than 0.05, mean +/- SE), and decreased normalized peak rates of left ventricular lengthening (from 5.3 sec-1 +/- 0.8 sec-1 to 3.9 sec-1 +/- 0.4 sec-1, less than 0.05) and posterior wall thinning (from 7.4 sec-1 +/- 1.0 sec-1 to 3.8 sec-1 +/- 0.6 sec-1, p less than 0.05). Parameters of systolic function as defined by fractional shortening, peak normalized rates of left ventricular shortening and posterior wall thinning were not altered by acute rejection. We conclude that the left ventricular function of non-rejecting hearts is similar to that of normals; however, acute rejection is associated with abnormal left ventricular diastolic dynamics without adverse effect on systolic function.