[Early vectorcardiographic diagnosis of rejection in long-term follow-up of heart transplantation].
A series of 194 transplant subjects was followed-up by over 2,600 vectorcardiograms. Several cases of rejection were chosen among the most patent and best documented cases (eight cases of acute rejection and seven cases of chronic rejection) and 15 control cases where all tests, including the vectorcardiogram, had always remained negative. Two criteria of rejection were used, i.e. the amplitude of the left maximum QRS vector less than 1.10 mV and relative right spatial area greater than 35 per cent. By accumulating all traces for each patient, recorded during and outside the rejection phase, it was found that the mean of the individual means was 0.96 mV for the left amplitude in cases of rejection versus 1.74 mV in the control group, and 44 versus 22 per cent for the right area. The first trace which, on the curves showing the progress of each patient, was likely to signal acute or chronic rejection always had a left amplitude less than 1 mV (mean 0.89 mV) and a right area greater than 33 per cent (mean 45%). The first suspicious trace always preceded the detection of signs by echography or biopsy (except in one case where it occurred at the same time). The interval varied from 16 to 112 days in five cases of rejection assessed as acute, and from 63 to 600 days in seven cases of chronic rejection. There was no echographic control in two other cases, but death occurred 45 and 63 days after the first vectorcardiographic signs. The vectorcardiogram improves after recovery from acute rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
Hacker
S
S
INSERM U 121, Hôpital Cardiologique, Lyon.
Morlet
D
D
Arnaud
P
P
Dureau
G
G
D005500:Follow-Up Studies; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D013997:Time Factors; D014672:Vectorcardiography
Diagnostic vectocardiographique précoce du rejet dans le suivi au long cours des transplantations cardiaques.