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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 969-979, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Noninvasive detection of cardiac allograft rejection by prospective telemetric monitoring

JS Pirolo, TS Shuman, EM Brunt, MJ Liptay, JL Cox and TB Ferguson Jr
Department of Surgery, Barnes Hospital, Washington University School of Medicine, St. Louis, MO.

A method for cardiac allograft surveillance that is less invasive than endomyocardial biopsy is needed. A fall in the unipolar peak-to-peak amplitude recorded from cardiac allografts has been shown to detect rejection when retrospectively compared with endomyocardial biopsy. This study was performed to assess the sensitivity and specificity of prospective telemetric unipolar peak-to-peak amplitude surveillance in detecting rejection of heterotopic canine cardiac allografts occurring through triple drug immunosuppression. Native heart and graft amplitudes were telemetrically acquired on a daily basis. A fall in normalized unipolar peak-to-peak graft amplitude to less than 85% was used as an indication for biopsy. A quantitative rejection score was calculated for each endomyocardial biopsy (rejection score greater than 0.66 = histologic rejection). Rejection was documented in all animals. Thirty-six biopsies were performed (10 control biopsies and 26 amplitude-directed biopsies); 25 of the 36 demonstrated rejection. Sensitivity and specificity were 88% and 91%, respectively. A linear correlation between unipolar peak-to-peak amplitude and rejection severity was seen (R = 0.87, p less than 0.001). The first true positive amplitude was associated with mild-to-moderate rejection (rejection score = 1.63 +/- 0.45). Unipolar peak-to-peak amplitude recorded from native hearts remained stable during allograft rejection. It is concluded that prospective, telemetric cardiac allograft surveillance can accurately detect rejection occurring through ongoing immunosuppression.

This article has been cited by other articles:

				J. E. Everett, M. N. Palmer, J. Jessurun, and S. J. Shumway Noninvasive Diagnosis of Cardiac Allograft Rejection in an Orthotopic Canine Model Ann. Thorac. Surg., November 1, 1996; 62(5): 1337 - 1340. [Abstract] [Full Text]