Abstract 19355: Tissue Doppler Imaging For Rejection Surveillance in Pediatric Heart Transplant Recipients

• Published in: Circulation (New York, N.Y.) N.Y.), 2012-11, Vol.126 (suppl_21)
• Main Authors: Lunze, Fatima I, Gauvreau, Kimberlee, Colan, Steven D, Blume, Elizabeth D, Smith, Rex Neal, Perez-Atayde, Antonio, Singh, Tajinder P
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.126.suppl_21.A19355

Abstract only Conventional echocardiography is not considered reliable for rejection-surveillance in pediatric heart transplant (HT) recipients. Pulse-wave tissue Doppler imaging (TDI) is geometry-independent and more sensitive than conventional imaging to evaluate bi-ventricular function. The purpose of this study was to assess TDI findings during biopsy-proven rejection in pediatric HT recipients and to develop TDI criteria for absence of rejection with high predictive accuracy. Methods: All HT recipients in follow-up at our center were included (N=122, median age at transplant 8.7 yrs, range 2 weeks-22 yrs). We identified all echocardiograms with TDI imaging performed within 24 hrs of an endomyocardial biopsy during 2005-2011. Rejection was defined as ISHLT Grade ≥2R cellular rejection or antibody-mediated rejection. Paired comparisons of TDI velocities were made using each patient’s baseline TDI as control. Results: Overall, 650 biopsy-pairs were identified where there was no rejection by biopsy at baseline (median duration between paired biopsies 4.3 mo, 25th-75th percentile 1-8.7 mo). In 25 of these pairs, the second biopsy demonstrated cellular or antibody mediated rejection. Rejection was associated with 27±17 % decline in LV S’ (P