Diagnosis of Rejection by Analyzing Ventricular Late Potentials in Heart Transplant Patients
| Autor: | Vítor Nogueira Mendes, Telmo Santos Pereira, Vítor Azevedo Matos |
|---|---|
| Jazyk: | English<br />Portuguese |
| Rok vydání: | 2016 |
| Předmět: | |
| Zdroj: | Arquivos Brasileiros de Cardiologia, Iss 0 (2016) |
| Druh dokumentu: | article |
| ISSN: | 1678-4170 20160011 |
| DOI: | 10.5935/abc.20160011 |
| Popis: | 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%. Conclusion: The SAECG distinguished between patients with and without rejection. The usefulness of the proposed risk score must be demonstrated in larger follow-up studies. |
| Databáze: | Directory of Open Access Journals |
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