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Heart. Oct 2001; 86(4): 432–437.
PMCID: PMC1729918
Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection
S Stengel, Y Allemann, M Zimmerli, E Lipp, N Kucher, P Mohacsi, and C Seiler
Cardiology, Swiss Cardiovascular Centre Bern, University Hospital, CH-3010 Bern, Switzerland.
OBJECTIVE—To test the hypothesis that diastolic mitral annular motion velocity, as determined by Doppler tissue imaging and left ventricular diastolic flow propagation velocity, is related to the histological degree of heart transplant rejection according to the International Society of Heart and Lung Transplantation (ISHLT).
METHODS—In 41 heart transplant recipients undergoing 151 myocardial biopsies, the following Doppler echocardiographic measurements were performed within one hour of biopsy: transmitral and pulmonary vein flow indices; mitral annular motion velocity indices; left ventricular diastolic flow propagation velocity.
RESULTS—Late diastolic mitral annular motion velocity (ADTI) and mitral annular systolic contraction velocity (SCDTI) were higher in patients with ISHLT < IIIA than in those with ISHLT [gt-or-equal, slanted] IIIA (ADTI, 8.8 cm/s v 7.7 cm/s (p = 0.03); SCDTI, 19.3 cm/s v 9.3 cm/s (p < 0.05)). Sensitivity and specificity of ADTI < 8.7 cm/s (the best cut off value) in predicting significant heart transplant rejection were 82% and 53%, respectively. Early diastolic mitral annular motion velocity (EDTI) and flow propagation velocity were not related to the histological degree of heart transplant rejection.
CONCLUSIONS—Doppler tissue imaging of the mitral annulus is useful in diagnosing heart transplant rejection because a high late diastolic mitral annular motion velocity can reliably exclude severe rejection. However, a reduced late diastolic mitral annular motion velocity cannot predict severe rejection reliably because it is not specific enough.


Keywords: heart transplant rejection; diastolic function; Doppler tissue imaging; echocardiography
Figure 1
Figure 1  
Doppler tissue imaging derived mitral annular motion velocity profiles obtained from the apical two chamber view from a heart transplant recipient. The following diastolic annular motion variables were measured: early (EDTI) and late (ADTI) diastolic (more ...)
Figure 2
Figure 2  
Measurement from colour Doppler M mode of left ventricular diastolic flow propagation velocity, which is determined by the slope of the first aliasing isovelocity line during early ventricular filling. The velocity is assessed from the apical four chamber (more ...)
Figure 3
Figure 3  
Changes in late diastolic mitral annular motion velocity (ADTI, cm/s, vertical axis) among patients without (ISHLT < IIIA) and with (ISHLT [gt-or-equal, slanted] IIIA) severe heart transplant rejection. ADTI [gt-or-equal, slanted] 8.7 cm/s (more ...)
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