Varani E, Mirri A, Iacobitti P, Magnani G, Caporale R, Boriani G, Ferretti R M, Ferrazzi P, Gamba A, Fiocchi R
Cardiologia. 1989 Nov;34(11):953-8.
The purpose of this study was to evaluate the sensibility of some clinical and non-invasive parameters in the early diagnosis of cardiac rejection in heart transplant patients. Eighteen patients (15 males and 3 females) aged 13-57 years (mean 44 +/- 14), with orthotopic heart transplant were followed clinically for a mean period of 15 +/- 8.7 months (range 3-27). They were all treated with cyclosporin, associated with azathioprine or prednisone, or both. During the same day of the endomyocardial biopsy, the patients were submitted to a clinical examination, 12 leads ECG and 2-dimensional and Doppler-echocardiography. The following parameters were evaluated: systolic and diastolic blood pressure, heart rate, body weight, summated QRS voltage in the 12 leads ECG, interventricular septum and left ventricular posterior wall end-diastolic thickness, left ventricular myocardial mass and fractional shortening, isovolumic relaxation time. Biopsy specimens were graded according to the Billingham criteria. Totally, 251 biopsies were performed: 130 were negative, 98 positive for mild or moderate rejection, 23 had a resolving rejection pattern; in 61 cases the patients were treated for acute rejection. Compared to negative biopsies, during acute rejection the QRS voltage and the isovolumic relaxation time significantly decreased, while left ventricular wall thickness and body weight increased. To evaluate the effects of the acute immunosuppressive therapy, the same parameters before and after treatment were compared. The QRS voltage, the wall thickness and the isovolumic relaxation time were significantly modified, returning to the pre-rejection values. In conclusion, both clinical and non-invasive information, may be useful to suspect an episode of acute rejection in heart transplant patients and to program myocardial biopsy.
本研究的目的是评估某些临床和非侵入性参数在心脏移植患者心脏排斥反应早期诊断中的敏感性。18例患者（15例男性和3例女性），年龄13 - 57岁（平均44±14岁），接受了原位心脏移植，临床随访平均时间为15±8.7个月（范围3 - 27个月）。他们均接受环孢素治疗，并联合硫唑嘌呤或泼尼松，或两者联用。在心肌内膜活检的同一天，对患者进行临床检查、12导联心电图及二维和多普勒超声心动图检查。评估了以下参数：收缩压和舒张压、心率、体重、12导联心电图的QRS综合电压、室间隔和左心室后壁舒张末期厚度、左心室心肌质量和缩短分数、等容舒张时间。活检标本根据比林厄姆标准进行分级。总共进行了251次活检：130次为阴性，98次为轻度或中度排斥反应阳性，23次有排斥反应缓解模式；61例患者接受了急性排斥反应治疗。与阴性活检相比，急性排斥反应期间QRS电压和等容舒张时间显著降低，而左心室壁厚度和体重增加。为了评估急性免疫抑制治疗的效果，比较了治疗前后的相同参数。QRS电压、壁厚度和等容舒张时间有显著改变，恢复到排斥反应前的值。总之，临床和非侵入性信息对于怀疑心脏移植患者发生急性排斥反应事件以及安排心肌活检可能都是有用的。
