Lessons learned with noninvasive cardiac monitoring for acute rejection.
BACKGROUND
Computerized Heart Allograft Rejection Monitoring (CHARM), used for noninvasive rejection monitoring in heart transplant recipients, is based on the analysis of ventricular evoked response (VER) signals. This study evaluated the prognostic validity of the TslewC, a parameter extrapolated from the VER.


METHODS
During orthotopic heart transplantation (OHT) 2 unipolar, fractally coated, screw-in leads implanted epimyocardially were connected to a telemetric pacemaker. Recordings of IEGMs were performed routinely at hospital and at outpatient visits. Data processing yielded trend curves. TslewC was calculated from the tangent of VER. One hundred five patients divided into survivors and nonsurvivors, were compared using a two-tailed Student's t test.


RESULTS
In the final follow-up a significant lower TslewC was observed among patients in the nonsurvivor compared with the other group (P<.001). Tests to find an optimal prognostic threshold of the TslewC yielded the value of 26 mV.


CONCLUSIONS
TslewC functioned as a prognostic factor after OHT. Further studies must provide a prognostic threshold to avoid patient visits all 4 weeks. Patients would only have to be admitted to the hospital if the TslewC was under this prognostic threshold.
Schweiger
M
M
Medical University Graz, University f. Surgery, Graz, Austria.
Wasler
A
A
Prenner
G
G
Rauchegger
G
G
Kniepeiss
D
D
Tscheliessnigg
K H
KH
D004784:Environmental Monitoring / Q000379:methods*; D005071:Evoked Potentials; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control*; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D010138:Pacemaker, Artificial; D013686:Telemetry; D016276:Ventricular Function