| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2000;120:737-745
© 2000 The American Association for Thoracic Surgery
Cardiothoracic Transplantation |
From the Departments of Cardiothoracic Surgery and Medicine, MCP Hahnemann University,a and the University of Pennsylvania Health System,b Philadelphia, Pa.
A preliminary report of this study was presented at the 20th Annual Scientific Sessions of North American Society of Pacing and Electrophysiology, Toronto, Ontario, Canada, 1999.
Address for reprints: J. Yasha Kresh, PhD, Professor and Research Director, Departments of Cardiothoracic Surgery and Medicine, MCP Hahnemann University, 245 N 15th St, MS 111, Philadelphia, PA 19102 (E-mail: j.yasha.kresh{at}drexel.edu).
Objective: The first months after orthotopic heart transplantation are associated with the highest risk of acute allograft rejection. This study explores the utility and reliability of linear and novel nonlinear metrics of heart rate variability as predictors of graft rejection. The underlying hypothesis is that the transplanted heart, in response to inflammatory mediators, alters the dynamic properties of its rhythm-generating system.
Methods: In a cross-sectional study of 45 patients who had undergone heart transplantation, spanning a period of 4 months after the operation, heart rate variability was examined by time- and frequency-domain analysis. The nonlinear features of heart rate variability were studied by computing a pointwise correlation dimension of R-R interval time series. The results of heart rate variability analysis were compared with those of endomyocardial surveillance biopsy studies using the International Society for Heart and Lung Transplantation scoring system.
Results: Duration of heart transplantation itself exhibited a significant (P < .05) association with the onset of rejection. Specific predictors of acute rejection based on heart rate variability were identified, including shortening of the R-R interval (from 700 ± 68 to 648 ± 72 ms), an increase in the ratio of low-frequency (0.04-0.15 Hz) to high-frequency (0.15-0.40 Hz) spectral power (from 0.3 ± 0.2 to 0.6 ± 0.4), and a decrease in pointwise correlation dimension values (from 1.7 ± 0.7 to 0.9 ± 0.3 units). Multivariable logistic regression analysis (R2 = 0.4) revealed that the only significant independent risk predictors were pointwise correlation dimension (odds ratio, 2.2 per 0.1 unit) and duration of heart transplantation (odds ratio, 1.7 per week).
Conclusion: Nonlinear measures of heart rate variability provide noninvasive means for identifying patients undergoing cardiac transplantation with acute rejection, thereby enabling the assessment of the time-dependent adaptive response of the donor heart to its host.
This article has been cited by other articles:
|
|
 |
|
  E. Nahshoni, D. Aravot, D. Aizenberg, M. Sigler, G. Zalsman, B. Strasberg, S. Imbar, E. Adler, and A. Weizman Heart Rate Variability in Patients With Major Depression Psychosomatics, April 1, 2004; 45(2): 129 - 134. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S-M Stengel, Y Allemann, M Zimmerli, E Lipp, N Kucher, P Mohacsi, and C Seiler Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection Heart, October 1, 2001; 86(4): 432 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kanno, Y.-J. L. Wu, P. C. Lee, S. J. Dodd, M. Williams, B. P. Griffith, and C. Ho Macrophage Accumulation Associated With Rat Cardiac Allograft Rejection Detected by Magnetic Resonance Imaging With Ultrasmall Superparamagnetic Iron Oxide Particles Circulation, August 21, 2001; 104(8): 934 - 938. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
