Evaluation of the role of conventional and tissue doppler imaging echocardiography in detection of acute cardiac allograft rejection in heart transplant recipients

Background: Endomyocardial Biopsy (EMB) is the gold standard test for diagnosis of acute allograft cardiac rejection. Objectives: The present study aimed to assess the role of echocardiographic parameters in discriminating patients with and without evidence of acute cardiac allograft rejection. Materials and Methods: In the present cross-sectional study, using convenience sampling, 63 EMB specimens were collected from the patients who had undergone biatrial orthotropic cardiac transplantation. The mean age of the recipients and donors was 30.46 ± 9.49 and 24.55 ± 7.64 years, respectively. There were 51(81) male recipients and 39(62) male donors. Echocardiographic examination was performed within the 24 hours of EMB. The data were entered into the SPSS statistical software, version 19 and were analyzed by chi-square test, student�s t-test, and one-way ANOVA as appropriated. All the data were two-tailed and P < 0.05 was considered to be statistically significant. Results: Among the 63 EMB specimens evaluated in the present study, mild and moderate acute rejections were seen in 19(30) and 5(8) cases, respectively. On Doppler examination, the three groups (without rejection, with mild rejection, and with moderate acute rejection) were significantly different only regarding trans-tricuspid E wave (P = 0.040). Pulsed-wave Tissue Doppler Imaging (TDI) also revealed a significant difference between the patients with and without allograft rejection regarding early diastolic tricuspid and mitral annular motion velocities (P = 0.005 and P = 0.02, respectively). Conclusions: It seems that echocardiographic parameters, including TDI, might be adjunct to, rather than substitution for, EMB findings for early diagnosis of acute allograft rejection. © 2016, Iranian Cardiovascular Research Journal. All right reserved

Prevalence of mechanical dyssynchrony in heart failure patients with different QRS durations

Background: Cardiac resynchronization therapy (CRT) has emerged as an established therapy for congestive heart failure. However, up to 30 of patients fail to respond to CRT despite prolonged QRS. Objectives: This study aimed at defining the prevalence of interventricular and intraventricular dyssynchrony in heart failure patients with different QRS durations. Methods: A total of 123 consecutive patients with severe heart failure (LVEF < 35 and NYHA class III-IV) were prospectively evaluated using 12-lead electrocardiogram and complete echocardiographic examination including tissue Doppler imaging. Results: According to the QRS duration, 56 patients had a QRS duration �120 ms (Group 1), 33 patients had a QRS duration between 120 and 150 ms (Group 2), and 34 patients had a QRS duration �150 ms (Group 3). Intraventricular dyssynchrony was present in 36 of Group 1 patients, in 58 of Group 2 patients, and in 79 of Group 3 patients (P < 0.000). Linear regression demonstrated a weak relation between QRS and intraventricular dyssynchrony. A greater proportion of patients with interventricular dyssynchrony was observed in Group 3 or Group 2 compared to patients with normal QRS duration (32 in Group 1 vs. 51.5 in Group 2 vs. 76.5 in Group 3, P < 0.000). Linear regression demonstrated a significant relation between QRS duration and interventricular mechanical delay. Conclusions: Although both interventricular and intraventricular dyssynchrony increased with the increasing QRS duration, the correlation between intraventricular mechanical and electrical dyssynchrony was weak. The lack of intraventricular dyssynchrony in a fraction of patients with standard CRT indication by QRS duration may provide us insight into the nonresponders rates. © 2007, The Authors

Significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure patients eligible for cardiac resynchronization: Particular focus on patients with right bundle branch block with and without coexistent left-sided conduction defects

Aims: The aim of this study was to assess the significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure (HF) patients considered eligible for cardiac resynchronization. Methods and results: A total of 200 consecutive HF patients (158 males, mean age 56 ± 13.5 years) with standard indications for cardiac resynchronization therapy (CRT) were evaluated prospectively. The prevalence of an interventricular mechanical delay �40 ms was lower in patients with pure right bundle branch block (RBBB) than that in those with RBBB plus left fascicular hemiblock (RBBB-LFH) and those with left bundle branch block (LBBB) (33 vs. 50 vs. 54, P = 0.05). A maximal difference in peak myocardial systolic velocity among all 12 segments (Ts)>100 ms was found in 63 of the patients with LBBB, whereas it was present in 31 of the patients with pure RBBB and in 42 of those with RBBB-LFH (P 34 ms was present in 58 of the LBBB subjects, but in only 29 and 42 of the patients with pure RBBB and RBBB-LFH, respectively (P < 0.001). Intraventricular dyssynchrony, however, was not different in patients with pure RBBB and in those with RBBB-LFH in terms of maximal difference in Ts (P = 0.25) and Ts-SD (P = 0.17). Conclusions: Although LBBB was more often associated with intraventricular dyssynchrony, ECG sign of additional left ventricular (LV) conduction delay is not a helpful tool for the identification of intra-LV mechanical dyssynchrony in HF patients with RBBB who would benefit from CRT. © The Author 2008