Diagnosis of Rejection by Analyzing Ventricular Late Potentials in Heart Transplant Patients

Abstract

BackgroundHeart transplant rejection originates slow and fragmented conduction. Signal-averaged ECG (SAECG) is a stratification method in the risk of rejection.ObjectiveTo develop a risk score for rejection, using SAECG variables.MethodsWe studied 28 transplant patients. First, we divided the sample into two groups based on the occurrence of acute rejection (5 with rejection and 23 without). In a second phase, we divided the sample considering the existence or not of rejection in at least one biopsy performed on the follow-up period (rejection pm1: 18 with rejection and 10 without).ResultsOn conventional ECG, the presence of fibrosis was the only criterion associated with acute rejection (OR = 19; 95% CI = 1.65-218.47; p = 0.02). Considering the rejection pm1, an association was found with the SAECG variables, mainly with RMS40 (OR = 0.97; 95% CI = 0.87-0.99; p = 0.03) and LAS40 (OR = 1.06; 95% IC = 1.01-1.11; p = 0.03). We formulated a risk score including those variables, and evaluated its discriminative performance in our sample. The presence of fibrosis with increasing of LAS40 and decreasing of RMS40 showed a good ability to distinguish between patients with and without rejection (AUC = 0.82; p < 0.01), assuming a cutoff point of sensitivity = 83.3% and specificity = 60%.ConclusionThe SAECG distinguished between patients with and without rejection. The usefulness of the proposed risk score must be demonstrated in larger follow-up studies.

Trasplante cardíaco en pequeños animales: las expectativas del avance de la impresión de corazón 3D para Medicina Veterinaria

“…Portanto, toda reação imunológica descrita pelos subtópicos representados a seguir não serão executados pelas células de defesa do organismo transplantado. Mendes et al (2016) argumentaram com base nos dados divulgados pela Sociedade Internacional para Transplante de Coração e Pulmão (ISHLT), que ocorre um percentual variante de 21% a 30% dos pacientes com transplante cardíaco que possuem o desenvolvimento de pelo menos um episódio de rejeição no primeiro ano após o procedimento de transplante. Em outra instituição pesquisada, CCT -CHUC, Centro de Cirurgia Cardiotorácica do Centro Hospitalar da Universidade de Coimbra, Mendes et al (2016) expõe que a incidência de rejeição é de 10% em 8,5 anos de seguimento clínico.…”

“…Mendes et al (2016) argumentaram com base nos dados divulgados pela Sociedade Internacional para Transplante de Coração e Pulmão (ISHLT), que ocorre um percentual variante de 21% a 30% dos pacientes com transplante cardíaco que possuem o desenvolvimento de pelo menos um episódio de rejeição no primeiro ano após o procedimento de transplante. Em outra instituição pesquisada, CCT -CHUC, Centro de Cirurgia Cardiotorácica do Centro Hospitalar da Universidade de Coimbra, Mendes et al (2016) expõe que a incidência de rejeição é de 10% em 8,5 anos de seguimento clínico. É de responsabilidade do cirurgião optar por uma abordagem cirúrgica menos invasiva ao organismo, que exija menos do paciente, o que consequentemente significará um pós-operatório com menor risco de infecção e de maior recuperação.…”

Signal-Averaged ECG: Basics to Current Issues

“…Several SAECG studies have been performed in patients who underwent heart transplant [20][21][22]. SAECG distinguished between heart transplant patients with or without rejection, especially LAS40 and RMS40 [22]. The association between LVPs and rejection of heart transplant is explained by occurrence of areas of myocardial ibrosis, due to cell changes caused by alloreactive T lymphocytes against graft antigens and ischemia-reperfusion injuries as soon as the blood low is reestablished [22].…”

“…Conduction delay contributed to ventricular dyssynchrony, regardless of LVPs in patients with heart failure, and LVPs did not play an important role in ventricular dyssynchrony [16]. Several SAECG studies have been performed in patients who underwent heart transplant [20][21][22]. SAECG distinguished between heart transplant patients with or without rejection, especially LAS40 and RMS40 [22].…”

“…SAECG distinguished between heart transplant patients with or without rejection, especially LAS40 and RMS40 [22]. The association between LVPs and rejection of heart transplant is explained by occurrence of areas of myocardial ibrosis, due to cell changes caused by alloreactive T lymphocytes against graft antigens and ischemia-reperfusion injuries as soon as the blood low is reestablished [22]. 20 young heart transplant patients SAECG is not efective in detecting heart transplant rejection in young patients Horenstein et al [21] Extracardiac disorders were also associated with LVPs, especially hypertension, metabolic syndrome, obesity, eating disorders, diabetes mellitus, renal failure, chronic obstructive pulmonary disease (COPD), acromegaly, thalassemia, connective tissue diseases, epilepsy, and schizophrenia [6,[23][24][25][26][27].…”