Schweiger M, Wasler A, Prenner G, Rauchegger G, Kniepeiss D, Tscheliessnigg K H
Medical University Graz, University f. Surgery, Graz, Austria.
Transplant Proc. 2007 Dec;39(10):3303-5. doi: 10.1016/j.transproceed.2007.09.005.
Computerized Heart Allograft Rejection Monitoring (CHARM), used for noninvasive rejection monitoring in heart transplant recipients, is based on the analysis of ventricular evoked response (VER) signals. This study evaluated the prognostic validity of the TslewC, a parameter extrapolated from the VER.
During orthotopic heart transplantation (OHT) 2 unipolar, fractally coated, screw-in leads implanted epimyocardially were connected to a telemetric pacemaker. Recordings of IEGMs were performed routinely at hospital and at outpatient visits. Data processing yielded trend curves. TslewC was calculated from the tangent of VER. One hundred five patients divided into survivors and nonsurvivors, were compared using a two-tailed Student's t test.
In the final follow-up a significant lower TslewC was observed among patients in the nonsurvivor compared with the other group (P<.001). Tests to find an optimal prognostic threshold of the TslewC yielded the value of 26 mV.
TslewC functioned as a prognostic factor after OHT. Further studies must provide a prognostic threshold to avoid patient visits all 4 weeks. Patients would only have to be admitted to the hospital if the TslewC was under this prognostic threshold.
用于心脏移植受者无创排斥监测的计算机化心脏移植排斥监测（CHARM）基于心室诱发反应（VER）信号分析。本研究评估了从VER推断出的参数TslewC的预后有效性。
在原位心脏移植（OHT）期间，将2个心外膜植入的单极、分形涂层螺旋电极连接到遥测起搏器。在医院和门诊常规进行心内心电图（IEGM）记录。数据处理产生趋势曲线。TslewC由VER的切线计算得出。使用双尾学生t检验比较105例分为存活者和非存活者的患者。
在最终随访中，与另一组相比，非存活患者的TslewC显著更低（P<0.001）。寻找TslewC最佳预后阈值的测试得出值为26 mV。
TslewC在OHT后起到预后因素的作用。进一步研究必须提供一个预后阈值，以避免患者每4周就诊一次。只有当TslewC低于此预后阈值时，患者才需要住院。
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