Key result
Serial measurement of epicardial evoked T wave amplitude detected initial cardiac transplant rejection episodes with 92% sensitivity and 100% specificity (P<0.005 for amplitude fall).
Why the study?
Does serial measurement of epicardial evoked T wave amplitude detect early cardiac transplant rejection in post-transplant patients?
Observational (n=13)
Does serial measurement of epicardial evoked T wave amplitude detect early cardiac transplant rejection in post-transplant patients?
p-value: p=<0.005
Serial measurement of epicardial evoked T wave amplitude using a pacemaker provides a highly sensitive and specific noninvasive method for detecting early cardiac transplant rejection.
May support noninvasive rejection monitoring post-transplant; hypothesis-generating and requires prospective validation before adoption.
Reliable diagnosis of cardiac allograft 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 endomyocardial 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 less than 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.
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Grace et al. (1991) conducted an observational in Cardiac transplant rejection (n=13). Serial measurement of epicardial evoked T wave amplitude vs. Endomyocardial biopsy (reference standard) was evaluated on Detection of initial biopsy-proven cardiac allograft rejection episode by fall in evoked T wave amplitude (p=<0.005). Serial measurement of epicardial evoked T wave amplitude detected initial cardiac transplant rejection episodes with 92% sensitivity and 100% specificity (P<0.005 for amplitude fall).
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