Dodd et al used echocardiography to identify cardiac transplant patients with acute rejection. This can help identify patients who should be aggressively evaluated. The authors are from Vanderbilt and Loma Linda Universities.
Parameters:
(1) left ventricular end diastolic volume (LVEDV) in mL per square meter BSA
(2) left ventricular wall mass (LVWM) in grams per square meter BSA (based on the formula of Devereux and Reicher, see 07.36.01 above)
(3) ratio of left ventricular end diastolic volume to left ventricular mass
(4) interventricular septum (IVS) thickening in mm
(5) left venticular posterior wall thickening (LVPW) in mm
(6) filling velocity of the left ventricle in mm per second
(7) maximum velocity of left venticular posterior wall thinning, normalized for chamber size at the time of maximum velocity, per second
(8) velocity of left ventricular posterior wall thinning in mm per second
(9) mitral or tricuspid valve insufficiency
Parameter 
Finding 
Points 

LVEDV 
>= 60% of predicted 
0 

< 60% of predicted 
2 
LVWM 
<= 130% of predicted 
0 

> 130% of normal 
1 
ratio LDEDV to LVWM 
>= 40% of predicted 
0 

< 40% of predicted 
1 
IVS thickening 
>= 25% of predicted 
0 

< 25% of predicted 
1 
LVPW thickening 
>= 70% of predicted 
0 

< 70% of predicted 
2 
filling velocity of left ventricle 
>= 60 mm per second 
0 

< 60 mm per second 
1 
maximum velocity of LVPW thinning normalized to chamber size 
>= 11 per second 
0 

< 11 per second 
2 
velocity of LVPW thinning 
>= 25 mm per second 
0 

< 25 mm per second 
1 
mitral or tricuspid valve insufficiency 
none 
0 

mild 
0 

moderate 
1 

severe 
1 
where:
• According to Graham et al, the normal left ventricular end diastolic volume is 60 mL per square meter BSA +/3 (Figure 2, page I64).
• According to Daniels et al, the mean left ventricular mass for males is 70.4 grams per square meter BSA; for females 60.7 grams per square meter (Table 3, page 707).
left ventricular shortening fraction =
= ((LVED)  (LVES)) / (LVED)
left ventricular end diastolic volume =
= (left ventricular end diastolic minor axis dimension) / 10
IVS thickening =
= ((IVS at end diastole)  (IVS at end systole)) / (IVS at end diastole)
LVPW thickening =
= ((LVPW at end diastole)  (LVPW at end systole)) / (LVPW at end diastole)
maximum velocity of LVPW thinning normalized to chamber size =
= (maximum velocity of LVPW thinning) / (left venticular diameter)
echocardiography score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 13
• A score >= 4 is considered indicative of acute rejection.
Additional features used to identify probable rejection  one or both of the following:
(1) left ventricular shortening fraction < 28%
(2) onset of a new pericardial effusion
Performance:
• Sensitivity 100%; specificity 75% (so additional testing is required to exclude rejection).
Purpose: To evaluate a patient with a cardiac transplant for echocardiographic evidence of acute rejection using the score of Dodd et al.
Specialty: Cardiology
Objective: clinical diagnosis, including family history for genetics, imaging studies
ICD10: T86.2, Z94.1,