Acute Cardiac Allograft Rejection Score

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

where:

• According to Graham et al, the normal left ventricular end diastolic volume is 60 mL per square meter BSA +/-3 (Figure 2, page I-64).

• 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).