Methods of cardiac allograft rejection monitoring
| Method | Delay | Serial assessment | Costs | Indication of rejection | Sensitivity | Specificity |
|---|---|---|---|---|---|---|
| JVD, jugular venous distension. | ||||||
| History | None | Yes | + | Dyspnoea, weight gain, discomfort | + | + |
| Physical exam | None | Yes | + | Arrhythmia, S3, crackles, JVD, oedema | + | + |
| ECG | None | Yes | + | Atrial arrhythmias, low voltage | + | + |
| Pacemaker | Telemetry | Every night | +++ | Voltage ↓ 7% | +++ | +++ |
| Echo | 30 mins | Yes | +++ | Isovolumic relaxation time ↓, fractional shortening ↓ | +++ | +++ |
| Biopsy | 24 hours | Max 1/week | +++ | Cell infiltrates, haemorrhage | +++ | +++ |
| Myosin scan | 24 hours | Max 1/3 month | +++ | Heart/lung ratio >1.6 | +++ | +++ |
| MRI | 1 hour | Max 1/week | +++ | Signal ↑ due to oedema | +++ | +++ |
| Immune monitoring | 4 hours | Yes | +++ | CD4/CD8↑, HLA-DR+/CD14 ↑, IL2↑ | +++ | +++ |