Echocardiographic Detection of Heart Transplant Graft Dysfunction

It would have seemed that the problem is relatively simple: graft rejection or coronary artery disease after cardiac transplantation induces edema, inflammation, myocyte damage, necrosis, ischemia, and sometimes fibrosis, resulting in ventricular systolic and diastolic dysfunction. These should be detectable by echocardiography; yet, the quest for a sufficiently sensitive, specific, and conclusive echo marker of orthotopic heart transplant (OHT) graft dysfunction has been elusive. Consequently, children with OHT may undergo repeated myocardial biopsies and coronary angiography to diagnose graft rejection and coronary artery disease. Although these procedures are associated with low risk overall, they are not without complications and entail considerable discomfort, especially in children, and may be performed repeatedly over the course of many years. Thus, it would be of substantial benefit to have an echo measure that can be applied simply and repeatedly to diagnose or exclude acute or chronic graft dysfunction.