The Prognostic Validity of the Ventricular Evoked Response (VER) Signals in Cardiac Transplantation

Schweiger, Martin; Wasler, A.; Prenner, G.; Tripolt, Michael; Rauchegger, Guenter; Tscheliessnigg, Karlheinz

doi:10.1016/j.healun.2005.04.014

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…Elektrokardiografski se mogu analizirati QRS--amplitude, varijabilnosti frekvencije i disperzije QT-intervala, ali s negativnom prediktivnosti točnosti (97%) i prognostičke vrijednosti s obzirom na sumnju na odbacivanje. 68 Ipak, neki autori smatraju da pojava aritmija s visokim stupnjem atrijske i ventrikularne ektopije, atrijske tahikardije (osobito undulacije), ventrikularne tahikardije i razvoja AV-bloka pobuđuju sumnju na odbacivanje i indikacija su za biopsiju miokarda i mimo protokola. 69,70 Ehokardiografska evaluacija najvažnija je neposredno nakon transplantacije kad se može posumnjati na odbacivanje presatka ako se nalaze smanjenje frakcije skraćenja lijeve klijetke, zadebljanje srčanih stijenki, patološki nalaz indeksa ventrikularne učinkovitoti (engl.…”

Section: Simptomi Odbacivanjaunclassified

Heart Transplantation in Children in Croatia – Our First Experiences

2018

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Sažetak. Uvod: Transplantacija srca (TS) prihvatljiva je metoda liječenja teških srčanih bolesti i kod djece kada se iscrpe sve ostale mogućnosti. Namijenjena je primarno djeci s kardiomiopatijama, rjeđe s teškim aritmijama ili prirođenim srčanim grješkama. Liječenje tom metodom nalaže multidisciplinarnu specijalističku suradnju te potporu okoline u kojoj dijete živi. Cilj: Glavni je cilj prikazati razvoj pedijatrijske transplantacijske kardiologije u Hrvatskoj. Sporedni je cilj podizanje svijesti o transplantaciji srca u djece, radi motivacije za donaciju organa jer je to najveći ograničava jući čimbenik ove metode. Rezultati studije: Prva transplantacija srca u djeteta učinjena je u Hrvatskoj 2011. godine. Priprema za transplantaciju napravljena je za 11-ero djece. Dvoje je umrlo na listi čekanja, jedno je skinuto s liste čekanja zbog oporavka, a u osmero je učinjena transplantacija; dvoje od njih je umrlo, jedno dijete neposredno nakon transplantacije, a jedno u ranome posttransplantacijskom razdoblju. Svi su pacijenti zadovoljili kriterije srčane insufi cijencije, četvero sa stadijem C-status 2 i sedmero sa stadijem D-status 1A i 1B. Od 11-ero koji su zadovoljili kriterije za TS svi su imali kardiomiopatiju, osmero dilatacijsku i troje restrikcijsku. U skupini bolesnika s dilatacijskom kardiomiopatijom nalaze se četiri s postmiokarditičnim DKM-om, jedan s idiopatskim, jedan u okviru aritmogenog KM-a, jedan u okviru entitetskog oblika koji se zove Carvajalov sindrom (ADVK/LV), dok je jedno dijete imalo DKM kod HLHS-a, ali kao NkKM. Od dvoje umrlih prije transplantacije jedno je dijete imalo postmiokarditični DKM, a jedno Carvajalov sindrom. Neposredno nakon transplantacije umrlo je dojenče sa sindromom hipoplastičnoga lijevog srca koje je prethodno imalo Norwoodove operacije I i II (Glennova operacija ili PCPC), a indikacija je bila teški DKM zbog i u okviru NkKM-a. PHD je pokazao hiperakutno odbacivanje. U ranome postoperativnom razdoblju umro je i 15-godišnji mladić s aritmogenim DKM-om, prethodno dugotrajno liječen konvencionalno i elektroterapijom, zbog zatajenja DV-a (možda zbog akutnoga staničnog odbacivanja). Podjednaka je zastupljenost prema spolu (ž : m) u cijeloj skupini (6 : 5) i u skupini transplantiranih (4 : 4). Srednja dob kod transplantacije srca bila je 84,8 mjeseci (22-167 mj.), a srednje vrijeme čekanja donora 53 dana (7-147 dana). Kaplan-Meierove krivulje za šestogodišnje razdoblje pokazuju 75%-tno preživljenje. U radu se opisuju brojne posttransplantacijske komplikacije, imunosupresivna terapija, protokol praćenja bolesnika i kvaliteta života. Prema kriterijima NYHA-e, nalazimo izrazito poboljšanje kvalitete života za sve bolesnike (pomak s 3-4 na 1-2). Zaključak: Transplantacija srca u našoj se Klinici provodi od 2011. godine. Uspješnost ovisi o pravodobnom postavljanju dijagnoze i prepoznavanju terminalnog stadija bolesti s još zadovoljenim uvjetima za transplantaciju (PVR < 6 Wj, TPG < 15 mmHg) te svijesti javnosti i liječnika u prepoznavanju potencijalnih donora. Preživljenje u šestogo...

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Section: Simptomi Odbacivanjaunclassified

Heart Transplantation in Children in Croatia – Our First Experiences

2018

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“…These responses are obtained via a telemetric pacemaker connected to unipolar epicardial electrodes implanted in both ventricles at the time of transplantation [57,58]. The ventricular evoked response is the sum of myocardial action potentials and these data may be transmitted wirelessly via the internet to a central data-processing unit for analysis.…”

Section: Intramyocardial Electrogramsmentioning

confidence: 99%

“…In addition to T slew , Schweiger et al [57,58] retrospectively calculated T slewc (T slew multiplied by VER duration) in 105 patients from the CHARM study between 1994-2003 [59]. They assessed T slewc in patients who survived during follow-up (n = 60) and compared these with those who died (n = 45).…”

Section: Intramyocardial Electrogramsmentioning

confidence: 99%

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Biomarkers of Acute Rejection Following Cardiac Transplantation

et al. 2014

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Cardiac transplantation can be a life-saving treatment for selected patients with heart failure. However, despite advances in immunosuppressive therapy, acute allograft rejection remains a significant cause of morbidity and mortality. The current 'gold standard' for rejection surveillance is endomyocardial biopsy, which aims to identify episodes of rejection prior to development of clinical manifestations. This is an invasive technique with a risk of false-positive and false-negative results. Consequently, a wide variety of noninvasive alternatives have been investigated for their potential role as biomarkers of rejection. This article reviews the evidence behind proposed alternatives such as imaging techniques, electrophysiological parameters and peripheral blood markers, and highlights the potential future role for biomarkers in cardiac transplantation as an adjunct to biopsy.

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“…Several teams have proposed using ventricular evoked responses that yield high negative predictive accuracy and prognostic value. 12 However, owing to conflicting results and lack of sufficient prospective data, the routine use of this tool for rejection screening is not recommended. 1 …”

Section: Introductionmentioning

confidence: 99%

Design of the DRAGET Study: a multicentre controlled diagnostic study to assess the detection of acute rejection in patients with heart transplant by means of T₂quantification with MRI in comparison to myocardial biopsies

et al. 2015

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IntroductionPatients with heart transplant are screened for silent graft rejection by recurrent endomyocardial biopsies. MRI can detect the presence of oedema non-invasively by quantitatively measuring changes of the transverse relaxation time T2 in the myocardium. Several monocentric studies have shown that T2 quantification could help detect graft rejection in a less invasive way. DRAGET is a national multicentre diagnostic study designed to prove that T2 quantification by MRI can detect graft rejection.Methods and analysis190 patients from 10 centres will undergo T2 quantification and endomyocardial biopsy, within 24 h, 4 to 6 times during the first year after transplantation. T2 will be computed by analysing a sequence of 10 images obtained from a short-axis slice. Specific phantoms will be used to calibrate the T2 quantification on each MR scanner to cope with the different equipment (different vendors, magnetic field strength, etc). Specific pads with known T2 will also be used during each examination and provide a quality check to cope with the different experimental conditions (temperature, etc). All MRI and biopsy data will be reinterpreted in our centre and reproducibility will be assessed. The primary outcome will be sensitivity and specificity of MRI. The secondary outcomes will be (1) prognostic values of T2, (2) reproducibility of each techniques, (3) number of adverse events during each procedures and (4) confidence of the physicians in T2.Ethics and disseminationEthics approval has been obtained. The new MRI method will be disseminated at a national level and its practical usefulness will be assessed in centres not familiar with MRI T2 quantification. The ultimate aim of the DRAGET project is to replace a strategy based solely on biopsy with one based on a first-line MRI (with biopsy only when needed) for a more efficient and less invasive detection of rejection.Trial registration numbersANSM 2014-A00848-39, NCT02261870.

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The Prognostic Validity of the Ventricular Evoked Response (VER) Signals in Cardiac Transplantation

Cited by 7 publications

References 14 publications

Heart Transplantation in Children in Croatia – Our First Experiences

Heart Transplantation in Children in Croatia – Our First Experiences

Biomarkers of Acute Rejection Following Cardiac Transplantation

Design of the DRAGET Study: a multicentre controlled diagnostic study to assess the detection of acute rejection in patients with heart transplant by means of T₂quantification with MRI in comparison to myocardial biopsies

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The Prognostic Validity of the Ventricular Evoked Response (VER) Signals in Cardiac Transplantation

Cited by 7 publications

References 14 publications

Heart Transplantation in Children in Croatia – Our First Experiences

Heart Transplantation in Children in Croatia – Our First Experiences

Biomarkers of Acute Rejection Following Cardiac Transplantation

Design of the DRAGET Study: a multicentre controlled diagnostic study to assess the detection of acute rejection in patients with heart transplant by means of T2quantification with MRI in comparison to myocardial biopsies

Contact Info

Product

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Design of the DRAGET Study: a multicentre controlled diagnostic study to assess the detection of acute rejection in patients with heart transplant by means of T₂quantification with MRI in comparison to myocardial biopsies