Non-invasive graft monitoring after heart transplantation: rationale to reduce the number of endomyocardial biopsies

Transplant International : Official Journal of the European Society for Organ Transplantation
B GrasserK H Tscheliessnigg

Abstract

The endomyocardial biopsy is invasive, reduces quality of life and cannot be repeated daily. Initial studies on noninvasive cardiac graft monitoring have been presented recently. During the heart transplant procedure, we implanted wideband telemetric pacemakers and fractally coated, epimyocardial electrodes. On biopsy days and during each follow-up, intramyocardial electrogram sequences were obtained. The maximum T-slew rate from the ventricular evoked response (VER) was automatically calculated and compared to the biopsy results (n = 331, ISHLT grading). The VER T-slew rate was significantly lower during rejection grade 2 or higher. The negative predictive value to exclude rejection was 98%. Using a single threshold diagnosis model, 74% of the biopsies could have been avoided. Noninvasive cardiac graft monitoring can reduce the need for surveillance biopsies and may offer a tool to optimize immunosuppressive therapy after heart transplantation.

References

Jul 17, 1998·Transplant International : Official Journal of the European Society for Organ Transplantation·B GrasserK Tscheliessnigg
Nov 24, 1998·Pacing and Clinical Electrophysiology : PACE·B GrasserK Tscheliessnigg

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Citations

Sep 10, 2003·Transplantation Proceedings·J M Arizón del PradoF Vallés Belsue
Sep 17, 2014·Biomarkers in Medicine·Jenna F McMinnRoy S Gardner
Mar 20, 2012·Translational Research : the Journal of Laboratory and Clinical Medicine·Carlos A Labarrere, Beate R Jaeger
Dec 20, 2007·Transplantation Proceedings·M SchweigerK H Tscheliessnigg
Oct 30, 2013·Transplant International : Official Journal of the European Society for Organ Transplantation·Laurent BonnemainsPierre-Yves Marie
Nov 22, 2005·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Martin SchweigerKarlheinz Tscheliessnigg
Nov 29, 2005·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Thomas Borth-Bruhns, Matthias Gass
Feb 14, 2006·Current Opinion in Cardiology·Jignesh K Patel, Jon A Kobashigawa

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