Related Experiment Videos
[Can solid state Holter monitoring replace endomyocardial biopsy in patients with heart transplantation?]
G Pochmalicki1, F Jan, C Benvenuti
1Service de cardiologie, CH Léon-Binet, Provins.
Insights
Silent myocardial ischemia (SMI) is uncommon during cardiac transplant rejection but is twice as long. Ventricular arrhythmias are common and correlate with rejection severity.
Area of Science:
- Cardiology
- Transplantation immunology
- Cardiac electrophysiology
Context:
- Acute cardiac graft rejection, diagnosed via endomyocardial biopsy, impairs coronary reserve due to microcirculation abnormalities.
- The relationship between reduced coronary reserve and silent myocardial ischemia (SMI) in heart transplant recipients remains unclear.
Purpose:
- To assess the frequency and duration of SMI and ventricular arrhythmias in heart transplant recipients during acute cardiac graft rejection.
Summary:
- This study analyzed 53 Holter recordings from 32 heart transplant patients within 24 hours of endomyocardial biopsy.
- Silent myocardial ischemia (SMI) was infrequent but lasted twice as long during rejection (80 min) compared to non-rejection periods (38 min).
- Ventricular arrhythmias, including VES, doublets, and non-sustained VT, were common and significantly correlated with the severity of cardiac rejection.
Impact:
- Silent myocardial ischemia (SMI) duration is prolonged during acute cardiac rejection, suggesting microcirculatory dysfunction.
- Ventricular arrhythmias are prevalent in cardiac rejection and serve as indicators of rejection severity.
- Findings highlight the importance of monitoring for both SMI and arrhythmias in heart transplant recipients to assess graft health.
Abstract:
Acute cardiac graft rejection after transplantation, the diagnosis of which is based on the findings of endomyocardial biopsy, is associated with a reduction in coronary reserve due to abnormalities of the microcirculation. But this reduction in coronary reserve cause silent myocardial ischaemia (SMI)? In order to assess the frequency of SMI and ventricular arrhythmias during rejection, 53 consecutive Holter recordings were performed in 32 patients (28 men, 4 women, average age 47 +/- 11 years) 11 months after transplantation and within 24 hours of endomyocardial biopsy. The recorder which was used (Monitor One TC) analysed the ST segment in 2 leads in real time: ST segment depression of more than 1 mm lasting over 40 ms, 0.08 s after the J point were considered to be diagnostic of myocardial ischaemia. Although the frequency of SMI is low and not specific for cardiac rejection, its duration was twice as long (80 mn vs 38 mn) in this condition. On the other hand, ventricular arrhythmias are common in cardiac rejection and correlated with its severity according to Billingham's classification (VES p = 0.045; doublets p = 0.035; non-sustained VT p = 0.006).