Assessment of the myocardial changes in heart transplant recipients without evident acute myocardial rejection by integrated backscatter: Comparison with simultaneous dobutamine stress echocardiography and 201thallium spect

Yi Lwun Ho, Chi Long Chen, Ron Bin Hsu, Lung Chun Lin, Ruoh Fang Yen, Chii Ming Lee, Ming Fong Chen, Por Jau Huang

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Cardiomyocyte hypertrophy and interstitial fibrin deposition develop in cardiac allografts and contribute to the functional changes of transplanted hearts. We hypothesized that integrated backscatter (IBS) can detect these myocardial changes. A total of 32 heart transplant recipients with either no or mild acute rejection (International Society of Heart and Lung Transplantation grade IA) were enrolled in this study. IBS data of myocardium were collected immediately before simultaneous dobutamine stress echocardiography (DSE) and 201thallium imaging. Coronary angiography and endomyocardial biopsy were also performed. Coronary angiography showed diffuse narrowing in 1 patient who also had abnormal results of IBS, DSE, and thallium results. In the other 31 patients with patent coronary arteries, there were 3 patients (10%) with abnormal DSE results, 19 patients (61%) with abnormal IBS patterns, and 16 patients (52%) with reversible thallium perfusion defects. Of the patients, 44% had cardiomyocyte hypertrophy and 56% interstitial fibrin deposition. There were significant differences in the prevalence of 201thallium perfusion defects and serum cyclosporine levels between patients with and without abnormal IBS patterns. Pathologic changes were also associated with abnormal IBS patterns (p = 0.01). However, there was no association between abnormal IBS and DSE results. By multiple logistic regression analysis, the abnormal IBS patterns were associated inversely with serum cyclosporine level (p = 0.028). In conclusion, abnormal IBS patterns are associated significantly with perfusion heterogeneity and pathologic changes in heart transplant recipients without evident acute myocardial rejection. There is no association between abnormal IBS patterns and dobutamine-induced dyssynergy in these patients. IBS provides a noninvasive approach for detection of myocardial changes in transplanted hearts without evident acute rejection. (E-mail:

Original languageEnglish
Pages (from-to)171-179
Number of pages9
JournalUltrasound in Medicine and Biology
Issue number2
Publication statusPublished - 2001
Externally publishedYes



  • Thallium perfusion scan
  • Dobutamine stress echocardiography
  • Heart transplantation
  • Integrated backscatter

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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