title: Diagnosis of Rejection by Analyzing Ventricular Late Potentials in Heart Transplant Patients.
abstract: BACKGROUND
  Heart transplant rejection originates slow and fragmented conduction. Signal-averaged ECG (SAECG) is a stratification method in the risk of rejection.
  
  
  OBJECTIVE
  To develop a risk score for rejection, using SAECG variables.
  
  
  METHODS
  We studied 28 transplant patients. First, we divided the sample into two groups based on the occurrence of acute rejection (5 with rejection and 23 without). In a second phase, we divided the sample considering the existence or not of rejection in at least one biopsy performed on the follow-up period (rejection pm1: 18 with rejection and 10 without).
  
  
  RESULTS
  On conventional ECG, the presence of fibrosis was the only criterion associated with acute rejection (OR = 19; 95% CI = 1.65-218.47; p = 0.02). Considering the rejection pm1, an association was found with the SAECG variables, mainly with RMS40 (OR = 0.97; 95% CI = 0.87-0.99; p = 0.03) and LAS40 (OR = 1.06; 95% IC = 1.01-1.11; p = 0.03). We formulated a risk score including those variables, and evaluated its discriminative performance in our sample. The presence of fibrosis with increasing of LAS40 and decreasing of RMS40 showed a good ability to distinguish between patients with and without rejection (AUC = 0.82; p < 0.01), assuming a cutoff point of sensitivity = 83.3% and specificity = 60%.
  
  
  CONCLUSIONS
  The SAECG distinguished between patients with and without rejection. The usefulness of the proposed risk score must be demonstrated in larger follow-up studies.
authors.affiliation: Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Vítor Nogueira
authors.initials: VN
authors.lastname: Mendes
authors.affiliation: Departamento de Cardiopneumologia, Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal.
authors.forename: Telmo Santos
authors.initials: TS
authors.lastname: Pereira
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Vítor Azevedo
authors.initials: VA
authors.lastname: Matos
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D004562:Electrocardiography / Q000379:methods*; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000175:diagnosis; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018754:Ventricular Dysfunction / Q000175:diagnosis / Q000503:physiopathology; D055815:Young Adult
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