Table 7

Methods of cardiac allograft rejection monitoring

MethodDelaySerial assessmentCostsIndication of rejectionSensitivitySpecificity
JVD, jugular venous distension.
HistoryNoneYes+Dyspnoea, weight gain, discomfort++
Physical examNoneYes+Arrhythmia, S3, crackles, JVD, oedema++
ECGNoneYes+Atrial arrhythmias, low voltage++
PacemakerTelemetryEvery night+++Voltage ↓ 7%++++++
Echo30 minsYes+++Isovolumic relaxation time ↓, fractional shortening ↓++++++
Biopsy24 hoursMax 1/week+++Cell infiltrates, haemorrhage++++++
Myosin scan24 hoursMax 1/3 month+++Heart/lung ratio >1.6++++++
MRI1 hourMax 1/week+++Signal ↑ due to oedema++++++
Immune monitoring4 hoursYes+++CD4/CD8↑, HLA-DR+/CD14 ↑, IL2↑++++++