[Electrocardiographic diagnosis of acute graft rejection after heart transplantation].
In order to evaluate the diagnostic value of standard-ECG (ST-ECG) and precordial mapping-ECG with 63 unipolar leads (PM-ECG) for detection of acute cardiac allograft rejection, 15 patients (12 male, 3 female; age range 24-64 years) were studied. ST-ECG and PM-ECG were recorded along with 94 endomyocardial biopsies. Twenty-four acute rejections were detected histologically. Using the ST-ECG, a reduction of the QRS-amplitude-sum (lead I, II, III, V1 and V6) greater than or equal to 5% in comparison with the ECG obtained 1 week before was found to be the best diagnostic criterion (sensitivity 63%, specificity 74%, positive predictive value 48%, negative predictive value 85%). By analysing the PM-ECG a drop of the QRS-amplitude greater than or equal to 12% in greater than or equal to 14/63 precordial leads was determined to be the most reliable parameter (sensitivity 79%, specificity 71%, positive predictive value 49%, negative predictive value 91%). In contrast to the high sensitivity of PM-ECG, ST-ECG was less suitable for detection of acute rejection. However, taking into account the high negative predictive value of PM-ECG, acute rejection could be excluded with high probability, if the QRS-amplitudes of the PM-ECG remained stable. This may lead to a lower frequency of routinely performed endomyocardial biopsies.
Völker
H
H
Medizinische Klinik I, RWTH Aachen.
Sigmund
M
M
Vogt
L
L
Silny
J
J
Kemnitz
J
J
Kirkpatrick
C J
CJ
Effert
S
S
Hanrath
P
P
D000328:Adult; D001706:Biopsy; D004562:Electrocardiography / Q000295:instrumentation*; D004699:Endocardium / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000473:pathology / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology; D016027:Heart Transplantation / Q000473:pathology / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*
Elektrokardiographische Diagnostik akuter Abstossungsreaktionen nach Herztransplantation.