Diagnosis of Early Cardiac Transplant Rejection by Fall in Evoked T Wave Amplitude Measured Using an Externalized QT Driven Rate Responsive Pacemaker
Reliable diagnosis of cardiac ailograft rejection is at present only possible using endomyocardial biopsy. We have serially measured epicardial evoked T wave amplitude during ventricular pacing with an externalized QT driven rate responsive pacemaker telemetered to a TP2 analyzer in 13 patients (12...
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| Veröffentlicht in: | Pacing and clinical electrophysiology 1991-06, Vol.14 (6), p.1024-1031 |
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| container_title | Pacing and clinical electrophysiology |
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| creator | GRACE, ANDREW A. NEWELL, STUART A. CARY, NATHANIEL R.B. SCOTT, JOHN P. LARGE, STEPHEN R. WALLWORK, JOHN SCHOFIELD, PETER M. |
| description | Reliable diagnosis of cardiac ailograft rejection is at present only possible using endomyocardial biopsy. We have serially measured epicardial evoked T wave amplitude during ventricular pacing with an externalized QT driven rate responsive pacemaker telemetered to a TP2 analyzer in 13 patients (12 males) followed for 19 (14–26) days after transplantation. A total of 228 records were analyzed. Rejection was defined on endom‐yocardial biopsy. On 17 of the 31 occasions on which biopsy was performed during the study, specimens showed significant (moderate) rejection. In 11 patients the initial biopsy proven rejection episode was associated with a significant fall in the evoked T wave amplitude from 1.3 (0.7–2.3) mV to 0.6 (0.5–1.8) mV (P < 0.005), which began 2 (1–4) days earlier. One patient with uncontrolled diabetes mellitus had no change in evoked T wave amplitude during rejection. The evoked T wave amplitude did not fall in the absence of histologic rejection. These results suggest a noninvasive method for detecting cardiac rejection, which appears both sensitive (92%) and specific (100%) in the first rejection episodes. |
| doi_str_mv | 10.1111/j.1540-8159.1991.tb04153.x |
| format | Article |
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We have serially measured epicardial evoked T wave amplitude during ventricular pacing with an externalized QT driven rate responsive pacemaker telemetered to a TP2 analyzer in 13 patients (12 males) followed for 19 (14–26) days after transplantation. A total of 228 records were analyzed. Rejection was defined on endom‐yocardial biopsy. On 17 of the 31 occasions on which biopsy was performed during the study, specimens showed significant (moderate) rejection. In 11 patients the initial biopsy proven rejection episode was associated with a significant fall in the evoked T wave amplitude from 1.3 (0.7–2.3) mV to 0.6 (0.5–1.8) mV (P < 0.005), which began 2 (1–4) days earlier. One patient with uncontrolled diabetes mellitus had no change in evoked T wave amplitude during rejection. The evoked T wave amplitude did not fall in the absence of histologic rejection. These results suggest a noninvasive method for detecting cardiac rejection, which appears both sensitive (92%) and specific (100%) in the first rejection episodes.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/j.1540-8159.1991.tb04153.x</identifier><identifier>PMID: 1715063</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Atrial Function - physiology ; Biopsy ; Cardiac Pacing, Artificial - methods ; cardiac transplantation ; Electrocardiography - drug effects ; Evoked Potentials - physiology ; evoked response ; Female ; Graft Rejection - physiopathology ; Heart Transplantation - pathology ; Heart Transplantation - physiology ; Humans ; Male ; Methylprednisolone - therapeutic use ; Middle Aged ; Myocardium - pathology ; Pacemaker, Artificial ; rate responsive pacemaker ; Time Factors ; Ventricular Function - physiology</subject><ispartof>Pacing and clinical electrophysiology, 1991-06, Vol.14 (6), p.1024-1031</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4094-ead21f791ce203f718725f4012f8a20e1b99a344a0aeb6a29e414edc7b9e7f753</citedby><cites>FETCH-LOGICAL-c4094-ead21f791ce203f718725f4012f8a20e1b99a344a0aeb6a29e414edc7b9e7f753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1540-8159.1991.tb04153.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1540-8159.1991.tb04153.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1715063$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GRACE, ANDREW A.</creatorcontrib><creatorcontrib>NEWELL, STUART A.</creatorcontrib><creatorcontrib>CARY, NATHANIEL R.B.</creatorcontrib><creatorcontrib>SCOTT, JOHN P.</creatorcontrib><creatorcontrib>LARGE, STEPHEN R.</creatorcontrib><creatorcontrib>WALLWORK, JOHN</creatorcontrib><creatorcontrib>SCHOFIELD, PETER M.</creatorcontrib><title>Diagnosis of Early Cardiac Transplant Rejection by Fall in Evoked T Wave Amplitude Measured Using an Externalized QT Driven Rate Responsive Pacemaker</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Reliable diagnosis of cardiac ailograft rejection is at present only possible using endomyocardial biopsy. We have serially measured epicardial evoked T wave amplitude during ventricular pacing with an externalized QT driven rate responsive pacemaker telemetered to a TP2 analyzer in 13 patients (12 males) followed for 19 (14–26) days after transplantation. A total of 228 records were analyzed. Rejection was defined on endom‐yocardial biopsy. On 17 of the 31 occasions on which biopsy was performed during the study, specimens showed significant (moderate) rejection. In 11 patients the initial biopsy proven rejection episode was associated with a significant fall in the evoked T wave amplitude from 1.3 (0.7–2.3) mV to 0.6 (0.5–1.8) mV (P < 0.005), which began 2 (1–4) days earlier. One patient with uncontrolled diabetes mellitus had no change in evoked T wave amplitude during rejection. The evoked T wave amplitude did not fall in the absence of histologic rejection. These results suggest a noninvasive method for detecting cardiac rejection, which appears both sensitive (92%) and specific (100%) in the first rejection episodes.</description><subject>Adult</subject><subject>Atrial Function - physiology</subject><subject>Biopsy</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>cardiac transplantation</subject><subject>Electrocardiography - drug effects</subject><subject>Evoked Potentials - physiology</subject><subject>evoked response</subject><subject>Female</subject><subject>Graft Rejection - physiopathology</subject><subject>Heart Transplantation - pathology</subject><subject>Heart Transplantation - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Methylprednisolone - therapeutic use</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Pacemaker, Artificial</subject><subject>rate responsive pacemaker</subject><subject>Time Factors</subject><subject>Ventricular Function - physiology</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1991</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkcGO0zAQhiMEWsrCIyBZHLgl2Ildx5yost0CWmCpulpu1iSZrNymSbCT0vIevC-OUi1n5jLS_P98lucPgjeMRszXu23EBKdhyoSKmFIs6nPKmUii45Ng9ig9DWaUcRmmSaqeBy-c21JK55SLi-CCSSboPJkFf64MPDStM460FVmCrU8kA1saKMjGQuO6GpqerHGLRW_ahuQncg11TUxDlod2hyXZkHs4IFnsu9r0Q4nkC4IbrFfunGkeCHjnsUfbQG1---n3Dbmy5oANWUOPHu26tnF-QG6hwD3s0L4MnlVQO3x17pfB3fVyk30Mb76tPmWLm7DgVPEQoYxZJRUrMKZJJVkqY1FxyuIqhZgiy5WChHOggPkcYoWccSwLmSuUlRTJZfB24na2_Tmg6_XeuAJr_2dsB6dlTAWNk9H4fjIWtnXOYqU7a_ZgT5pRPWait3o8vB4Pr8dM9DkTffTLr8-vDPkey3-rUwhe_zDpv0yNp_8g69tFtmQ05h4RTgjjejw-IsDu9FwmUuj7ryu9zvhK_PgsNU_-AkaArOM</recordid><startdate>199106</startdate><enddate>199106</enddate><creator>GRACE, ANDREW A.</creator><creator>NEWELL, STUART A.</creator><creator>CARY, NATHANIEL R.B.</creator><creator>SCOTT, JOHN P.</creator><creator>LARGE, STEPHEN R.</creator><creator>WALLWORK, JOHN</creator><creator>SCHOFIELD, PETER M.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199106</creationdate><title>Diagnosis of Early Cardiac Transplant Rejection by Fall in Evoked T Wave Amplitude Measured Using an Externalized QT Driven Rate Responsive Pacemaker</title><author>GRACE, ANDREW A. ; 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We have serially measured epicardial evoked T wave amplitude during ventricular pacing with an externalized QT driven rate responsive pacemaker telemetered to a TP2 analyzer in 13 patients (12 males) followed for 19 (14–26) days after transplantation. A total of 228 records were analyzed. Rejection was defined on endom‐yocardial biopsy. On 17 of the 31 occasions on which biopsy was performed during the study, specimens showed significant (moderate) rejection. In 11 patients the initial biopsy proven rejection episode was associated with a significant fall in the evoked T wave amplitude from 1.3 (0.7–2.3) mV to 0.6 (0.5–1.8) mV (P < 0.005), which began 2 (1–4) days earlier. One patient with uncontrolled diabetes mellitus had no change in evoked T wave amplitude during rejection. The evoked T wave amplitude did not fall in the absence of histologic rejection. These results suggest a noninvasive method for detecting cardiac rejection, which appears both sensitive (92%) and specific (100%) in the first rejection episodes.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>1715063</pmid><doi>10.1111/j.1540-8159.1991.tb04153.x</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Atrial Function - physiology Biopsy Cardiac Pacing, Artificial - methods cardiac transplantation Electrocardiography - drug effects Evoked Potentials - physiology evoked response Female Graft Rejection - physiopathology Heart Transplantation - pathology Heart Transplantation - physiology Humans Male Methylprednisolone - therapeutic use Middle Aged Myocardium - pathology Pacemaker, Artificial rate responsive pacemaker Time Factors Ventricular Function - physiology |
| title | Diagnosis of Early Cardiac Transplant Rejection by Fall in Evoked T Wave Amplitude Measured Using an Externalized QT Driven Rate Responsive Pacemaker |
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