Résumé
Acute rejection, cellular or humoral, is one of main principal complications of heart transplant. The Gold standard for its diagnosis is endomyocardial biopsy (EBM), which is an invasive exam. Objective: the aim of our investigation is to examine contribution of non invasive exams used in routine: cardiac ultrasound, biology (sST2, troponin and NT-pro-BNP) and cardiac MRI, to diagnose as early as possible acute rejection, humoral and/or cellular, and its severity.Methods: all patients with heart transplant admitted for EBM at Montpellier UHC were included, prospectively. A transthoracic echography (TTE) and/or a blood sample with troponin, NT-pro-BNP and/or sST2 were also performed. Cardiac MRI was carried out at six weeks, six months and one year of transplantation.Results: between september 2019 and june 2020, 124 EBM were performed in 61 patients. 27 EBM highlighted an acute rejection (21.7%.) Patients with acute rejection have significantly lower left ventricular ejection fraction (59.60 ±8.61 versus 64.03 ±7.45; p= 0.02) and LGS (-13.29 ± 2.08 versus -14.46 ± 2.36, p= 0.05.) Among MRI data, involvement of septal territory in T1 mapping abnormalities is statistically more common in patients with acute rejection than in patients without rejection (71.4% versus 15.8%; p= 0.01.) Biological parameters values are similar in the two groups. Conclusion: LGS in TTE and T1 mapping in cardiac MRI seem to be interesting tools in early detection of acute rejection and could be used to guide EBM realization.