Do right ventricular indices by doppler echo provide an incremental value to predict cardiac rejection after transplantion?

Previous studies suggested changes in Doppler indices of left ventricular (LV) filling might be related to cardiac rejection. However, the goal of Doppler echo as a noninvasive indicator of transplant rejection has not yet been achieved. We hypothesized that right ventricular (RV) Doppler diastolic and systolic parameters could provide an incremental value to predict cardiac rejection. 132 Doppler echo and cardiac biopsy examinations were performed on the same day in fifty nine patients. LV isovohimic relaxation time (IVRT) was measured as a time interval between the ending of aortic outflow and the beginning of mitral inflow by Doppler CW recordings from apical 5-chamber view. RV-IVRT was obtained from heart rate matched pulmonary outflow and tricuspid inflow Doppler PW recordings. Tricuspid early (E) and atrial (A) filling velocities were obtained from RV inflow Doppler recordings at 4-chamber view. RV systolic time (pre-ejection time/ejection time, STI) and pulmonary acceleration time (Accl T) were measured from pulmonary arterial flow at the short axis view. Tricuspid annulus diameter as an index of RV size (RVd) was also measured from the apical 4-chamber view. Biopsy findings were graded based on ISHLT system: none (0), mild (1A,B), moderate (2, 3A) and severe (3B, 4) rejection. Results (mean±SE): None (65) Mild (43) Moderate (15) Severe (9) LV-IVRT(ms) 85±2 84±3 80±5 66±6*1 RV-IVRT 68±4 65±5 67±7 46±5*RV-E/A 1.6±.1 1.6±.1 2.0±.5 2.1±.6 Accl(ms) 88±3 84±3 83±9 81+14 STI.45±.02 .43±.02 .50±.07 .61±.09*RVd(cm) 3.7±.1 3.8±.1 3.8±.1 3.9±.1*p<0.05, severe vs none; 1 p<0.05, severe vs mild Thus, the significant changes in Doppler parameters from LV or RV were observed only with severe rejection. RV Doppler did not provide an incremental value to predict early stages of cardiac rejection after transplantation.