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Die Messung und Analyse der bioelektrischen myokardialen Impedanz als nichtinvasive Methode zur Abstoßungsdiagnostik nach Herztransplantation

The measurement and analysis of the bioelectrical myocardial impedance as a noninvasive method for rejection monitoring after heart-transplantation

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Zeitschrift für Herz-, Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

12 Beagle-Hunde wurden einer Halsherztransplantation unterzogen und mit Cyclosporin A und Methylprednisolon immunsupprimiert. Die intramyokardiale Impedanz wurde zweimal täglich über zwei im rechts- und linksventrikulären Myokard positionierte Schraubelektroden gemessen. Transmyokardiale Stanzbiopsien und das intramyokardiale Elektrogramm (IMEG) galten als Referenzmethoden. Insgesamt wurden 19 akuten Abstoßungsepisoden induziert. Nach histologischer Sicherung einer akuten Abstoßungsreaktion erfolgte die Abstoßungsbehandlung mit jeweils 125 mg Methylprednisolon-Stößen an fünf aufeinanderfolgenden Tagen sowie die Anhebung des Cyclosporin A-Spiegels auf suffiziente Werte. Alle Herzen zeigten unmittelbar nach Transplantation einen einheitlichen Impedanzabfall im hochfrequenten Bereich um 28,3%±5,5% und erreichten dann nach 8–10 Tagen ein stabiles Niveau. Solange keine Abstoßungsreaktionen induziert wurden blieben die Impedanzwerte unverändert. Die histologische Diagnose einer, akuten Abstoßungsreaktion Grad 1 A 1 B (ISHLT) wurde von einem Anstieg der Impedanzwerte um 12,2%±2,5%, bei Grad 2–3A um 19,2%±3,2% und bei Grad 3B-4 um 27,0%±2,9% begleitet. Die Sensitivität betrug 100%, die Spezifität 97%. Die erfolgreiche Behandlung einer Abstoßungsreaktion führte wieder zum Abfall der Impedanzwerte auf ihr Ausgangsniveau. Die Messung der intramyokardialen Impedanz kann im Bereich hoher Frequenzen zuverlässig Zustandsänderungen der Zellmembran und des Intrazellulärraumes während akuter Abstoßungsreaktionen nach Herztransplantation aufzeigen und ist ein zuverlässiger nichtinvasiver Parameter zur Graduierung des Schweregrades akuter Abstoßungsreaktionen. Ebenso ist die Kontrolle des Behandlungsverlaufs und-erfolges mittels Impedanz möglich. Diese nichtinvasive Methode ist mit einer dem Herzschrittmacher vergleichbaren implantierbaren telemetriefähigen Einheit anwendbar und ermöglicht die kontinuierliche Abstoßungsüberwachung des Patienten zu Hause ohne Klinikaufenthalt.

Summary

12 beagle dogs underwent neck-heart transplantation and were immunosuppressed with cyclosporine and methylprednisolone. Intramyocardial impedance was determined twice daily with four screw-in electrodes in the right and left ventricles. Transmyocardial biopsies and the intramyocardial electrogram (IMEG) were performed as reference methods. Nineteen rejection episodes were induced. When acute rejection was seen in histology the animals were treated with pulsed 125 mg methylprednisolone over 5 consecutive days and immunosuppression was raisod to sufficient levels. Successful treatment of rejection was controlled by biopsy. All hearts showed a uniform decrease of impedance of about 28.3%±5.5% immediately after implantation, then reaching a stable plateau after 7 to 8 days. Impedance values then remained unchanged as long as rejection was absent. Biopsy findings of grade 1A to 1B (ISHLT) were accompanied by statistically significant increase of impedance of 12.2%±2.5%; of grade 2 to 3A of 19,2% ±3.2% and of grade 3B to 4 of 27.0%±2.9%. Sensivity was 100%, specificity 97%. Successful treatment of rejection led to a uniform decrease of impedance to initial levels. Measurements of the intramyocardial impedance for high frequencies can reliably indicate alterations of the cell membrane and the intracellular space during acute cardiac allograft rejection. The amount of increase of impedance is a reliable nonivasive parameter to graduate acute cardiac allograft rejection. The success of treatment of rejection can also be monitored by impedance. This noninvasive method is applicable for telemetric rejection monitoring via an implantable device, which would allow continuous rejection surveillance of a patient at home without hospital admission.

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  1. Abt. Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin

    R. Pfitzmann, J. Müller, O. Grauhan, T. Cohnert & R. Hetzer

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  1. R. Pfitzmann
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  2. J. Müller
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  3. O. Grauhan
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  4. T. Cohnert
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  5. R. Hetzer
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Pfitzmann, R., Müller, J., Grauhan, O. et al. Die Messung und Analyse der bioelektrischen myokardialen Impedanz als nichtinvasive Methode zur Abstoßungsdiagnostik nach Herztransplantation. Z. Herz-, Thorax-, Gefäßchir. 11, 47–61 (1997). https://doi.org/10.1007/BF03043238

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