Abstract
Acute rejection is a major challenge for the control of heart transplant recipients. The diagnosis of rejection is still based on endomyocardial biopsy as the ‘gold standard’, although there are limitations of this procedure. The major limitation being that it is an invasive method and thereby cannot be performed daily in the acute phase after heart transplantation. Furthermore, there are sufficient data to show that autopsy-acquired cardiac allograph specimens are not representative of the whole heart1. Because of this sampling error it is inappropriate to base diagnosis of cardiac rejection exclusively on endomyocardial biopsy. Non-invasive methods are strongly needed. Unfortunately, conventional ECG analysis in the time domain does not allow an early detection of rejection since the introduction of cyclosporine2. Patients treated with cyclosporine show milder forms of rejection with a less degree of cellular infiltration, edema and myocyte necroses. As a consequence, a decrease of QRS voltage, previously a consistent finding in both the experimental3 and clinical setting4, became unreliable for detection of mild or moderate rejection. Furthermore QRS amplitude is subject to considerable circadian changes5,6.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Zerbe TR, Arena V. Diagnostic reliability of endomyocardial biopsy for assessment of cardiac allograft rejection. Hum Pathol. 1988;19:1307–14.
Oyer PE, Stinson EB, Jamieson SW, Hunt SA, Billingham M, Scott W, Bieber CP, Reitz BA, Shumway NE. Cyclosporin-a in cardiac allografting: A preliminary experience. Transplant Proc. 1983;15:1247–52.
Cooper DK, Charles RG, Rose AG, Fraser RC, Isaacs S, Novitzky D, Barnard CN. Does the electrocardiogram detect early acute heart rejection. J Heart Transplant. 1985;4(5):546–9.
Stinson EB, Dong E, Bieber CP, Schroeder JS, Shumway NE. Cardiac transplantation in men. 1. Early rejection. JAMA. 1969;207:2233–42.
Willems JL, Poblete PF, Pipberger HV. Day-to-day variation of the normal orthogonal electrocardiogram and vectorcardiogram. Circulation. 1972;45:1057–64.
Losman JG, McDonald J, Levine HD, Campbell CD, Replogle RL. The variation of the electrocardiographic voltage during the day in normal subjects. Heart Transplant. 1982;I:39–51.
Haberl R, Weber M, Reichenspurner H, Kemkes BM, Osterholzer G, Anthuber M, Steinbeck G. Frequency analysis of the surface electrocardiogram for recognition of acute rejection after orthotopic cardiac transplantation in man. Circulation. 1987;76(1):101–8.
Haberl R, Weber M, Kemkes BM, Steinbeck G. Fourier transform of electrocardiogram for noninvasive recognition of acute rejection after orthotopic heart transplantation in man. In Kellermann JJ, editor. New Trends in Heart Transplantation. Bibl Cardiol. Basel: Karger Verlag; 1988:128–32.
Billingham ME. Diagnosis of cardiac rejection by endomyocardial biopsy. Heart Transplant. 1982;1:25.
Reith R, Haberl R, Luchner A, Weber M, Schütz A, Gokel JM, Kemkes BM, Steinbeck G. Erkennung akuter Abstoßungsreaktionen mit Fourier Transformation des Oberflächen-EKG im Langzeitverlauf nach Herztransplantation. Z Kardiol. 1991;80:258–65.
Weber M, Manz C, Haberl R, Schütz A, Gokel M, Kemkes BM, Steinbeck G. Daily comparison between spectral analysis of the ECG and myocardial biopsy for detection of acute rejection after heart transplantation in dogs. Circulation. 1990;82:257.
Weber M, Manz C, Haberl R, Schütz A, Engelhardt M, Gokel J, Kemkes B, Steinbeck G. Spectral analysis of the ECG for detection of acute rejection after heart transplantation in dogs: comparison with daily myocardial biopsy. Eur Heart J. 1990;11:257.
Warnecke H, Schüler S, Goetze HJ, Matheis G, Süthoff U, Müller J, Tietze U, Hetzer R. Noninvasive monitoring of cardiac allograft rejection by intramyocardial electrogram recordings. Circulation. 1986;74(suppl.):III-72–6.
Wahlers T, Haverich A, Schaefers H J, Frimpong-Boateng K, Fieguth HG, Herrmann G, Borst HG, Arvanitidou V. Changes of the intramyocardial electrogram after orthotopic heart transplantation. J Heart Transplant. 1986;5(6):450–4.
Keren A, Gillis AM, Freedman RA, Baldwin JC, Billingham ME, Stinson EB, Simson MB, Mason JW. Heart transplant rejection monitored by signal-averaged electrocardiography in patients receiving cyclosporine. Circulation. 1984;70(suppl.):I124–9.
Sands KE, Appel ML, Lilly LS, Schoen FJ, Mudge GH Jr, Cohen RJ. Power spectrum analysis of heart rate variability in human cardiac transplant recipients. Circulation. 1989;79(l):76–82.
Zbilut JP, Murdock DK, Lawson L et al. Use of power spectral analysis of respiratory sinus arrhythmia to detect graft rejection. J Heart Transplant. 1988;7:280.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Haberl, R. et al. (1993). Spectral analysis of the surface ECG for noninvasive detection of acute rejection after heart transplantation. In: Gomes, J.A. (eds) Signal Averaged Electrocardiography. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-0894-2_33
Download citation
DOI: https://doi.org/10.1007/978-94-011-0894-2_33
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-010-4386-1
Online ISBN: 978-94-011-0894-2
eBook Packages: Springer Book Archive