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DOI: 10.1055/s-2001-18135
Nicht-invasive Überwachung von Abstoßungsreaktionen nach Herztransplantation
Eine Übersicht über die Methode und retrospektive Analyse der Daten von 734 PatientenNon-invasive monitoring of rejection after cardiac transplantation. The method and retrospective analysis of data on 734 patientsPublikationsverlauf
Publikationsdatum:
31. Oktober 2001 (online)

Hintergrund und Fragestellung: Die Endomyokardbiopsie ist der Goldstandard zur Abstoßungsüberwachung nach Herztransplantation. Bei Anwendung dieser invasiven Methode ist aufgrund von Abstoßungsreaktionen mit einer Mortalitätsrate von 5 - 6 % im ersten postoperativen Jahr zu rechnen. Das Ziel dieser retrospektiven Analyse war es, die diagnostische Zuverlässigkeit einer nichtinvasiven elektrophysiologischen Methode zur Abstoßungsüberwachung zu überprüfen.
Patienten und Methodik: Dazu wurde täglich die QRS-Komplexamplitude des intramyokardialen Elektrogramms über einen Schrittmacher mit Telemetriefunktion in dem Zeitraum eines Jahres gemessen. Als Kriterium für den Verdacht einer Abstoßung wurde der Abfall der QRS-Komplexamplitude von mehr als 8 % gewertet. Von 734 Patienten wurden 558 in die Studie eingeschlossen. Eine Biopsie wurde nur dann vorgenommen, wenn die nichtinvasiven Methoden (QRS-Komplexamplitude plus Echokardiographie) diskrepante Ergebnisse zeigten.
Ergebnisse: Keiner der Patienten starb an einer Abstoßungsreaktion, 273 wurden mindestens einmal und 285 nie biopsiert. Die Methode erreichte eine Sensitivität von 0,9777, eine Spezifität von 0,9634, einen negativen prädiktiven Wert von 0,9850 und einen positiven prädiktiven Wert von 0,9459.
Folgerung: Die tägliche elektrophysiologische nichtinvasive Abstoßungsüberwachung scheint der invasiven Endomyokardbiopsie überlegen zu sein, da die durch Abstoßungsreaktionenen bedingte Mortalitätsrate bei gleichzeitiger geringerer Zahl an Endomyokardbiopsien deutlich reduziert werden konnte.
Non-invasive monitoring of rejection after cardiac transplantation. The method and retrospective analysis of data on 734 patients
Background and objective: Endomyocardial biopsy is the gold standard for monitoring rejection in cardiac recipients. The death rate due to rejection with this invasive method is 5-6 % in the first postoperative year. The aim of this retrospective data analysis from cardiac recipients was to prove the diagnostic reliability of a non-invasive electrophysiological method for rejection monitoring.
Patients and methods: We daily analyzed the QRS-complex amplitude of the intramyocardial electrogram, which we received over a period from one year via a pacemaker with a telemetric capability. The diagnostic guideline for a suspected rejection was the reduction of the QRS-complex amplitude by more than 8 %. Out of 734 patients 558 were included in the study. Biopsy was only performed when the non-invasive rejection monitoring data (QRS-complex amplitude plus echocardiography) showed a discrepancy for rejection.
Results: None of the patients died due to rejection, 273 at least once underwent a biopsy, and 285 never had a biopsy. The method reached a sensitivity of 0.9777, a specificity of 0.9634, a negative predictive value of 0.9850, and a positive predictive value of 0.9459.
Conclusion: Daily electrophysiological non-invasive monitoring of rejection seems to be superior to endomyocardial biopsy. Death of patients due to rejection can be minimised. The number of necessary biopsies can be drastically reduced when compared to the usual number performed.
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Korrespondenz
Dr. Johannes Müller
Deutsches Herzzentrum Berlin
Augustenburger Platz 1
13353 Berlin
Telefon: 030/45932033
Fax: 030/45932170
eMail: jmueller@dhzb.de