Rodríguez-Ortega MF, Archundia GA, Díaz QG, Aceves CJL

Language: Spanish
References: 30
Page: 160-164
PDF size: 47.01 Kb.

ABSTRACT

Objective: To describe the relation between the echocardiographic and histological changes during acute rejection of cardiac transplants.
Setting: Nacional Medical Center “20 de Noviembre” ISSSTE.
Design: Trasversal, observational, descriptive, retrolective study.
Statistics: Central tendency and dispersion measures, Spearman’s rho, and sensitivity, specificity, positive and negativa predictive values.
Patients and method: Clinical records of 11 patients with cardiac transplant performed between August 1990 and August 2005. Analyzed variables were: gender, age, etiology of the cardiopathy, functional class according to the New York Heart Association (NYHA), histological and echocardiographic findings, immunologic rejection according to the International Society of Heart and Lung Transplantation of 1990 and 2004.
Results: Nine patients were men, all with antecedent of idiopatic dilated cardiomyopathy, age range from 25 to 57 years, class NYHA III (n = 4) and IV (n = 7). After the transplantation and at the moment of getting the information from the clinical record, only patient 11 was found in class IV, the remainder was in functional class II. Endocardial biopsies revealed a slight degree of rejection in 6 patients, moderate in two, one patient with severe, and two patients revealed no rejection. Tricuspid failure was graded as slight to moderate in patients 2, 5, and 8, and of severe in patient 11. Immunological rejection due to altered time of isovolumetric relaxation of the left ventricle, valve dysfunction, and low ejection fraction was found in 2, 5, 7, and 11. With a 0.72 (p ‹ 0.04) immunological rejection and with a 0.62 (p ‹ 0.05) rejection degree by Spearman’s rho, sensitivity of 75%, positive predictive value of 75%.
Conclusion: The time of isovolumetric relaxation and valve dysfunction determined by conventional echocardiography depict a good relation with the histological findings and can be useful for the diagnosis of immunological rejection in patients with cardiac transplant.

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