心脏移植受者急性移植物排斥的心电图相关性。

Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients.

机构信息

Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan.

出版信息

Am J Crit Care. 2018 Mar;27(2):145-150. doi: 10.4037/ajcc2018862.

DOI:10.4037/ajcc2018862

PMID:29496772

Abstract

BACKGROUND

Acute allograft rejection appears to be associated with increases in QT/QTc intervals.

OBJECTIVES

To determine the relationship between acute allograft rejection and electrocardiogram changes in patients undergoing an orthotopic heart transplant.

METHODS

The study population comprised 220 adult patients undergoing heart transplant and enrolled in the NEW HEART study. Electrocardiograms obtained within 72 hours of endomyocardial biopsy were analyzed; electrocardiograms obtained fewer than 10 days after transplant surgery were excluded. Repeated-measures analysis was performed with statistical models including effects for rejection severity (mild and moderate/severe) and time trends independent of rejection status.

RESULTS

The 151 male and 69 female transplant recipients (mean age [SD], 54 [13] years) had 969 biopsy/electrocardiogram pairs: 677 with no rejection, 280 with mild rejection, and 12 with moderate/severe rejection. Moderate to severe organ rejection was associated with significant increases in QRS duration ( < .001), QT ( = .009), QTc ( = .003), and PR interval ( = .03), as well as increased odds of right bundle block branch ( = .002) and fascicular block ( = .009) occurring.

CONCLUSIONS

Moderate to severe acute allograft rejection was associated with electrocardiographic changes after transplant surgery. Studies are needed to assess the value of computerized electrocardiogram measurement algorithms for detecting acute allograft rejection.

摘要

背景

急性移植物排斥反应似乎与 QT/QTc 间期的增加有关。

目的

确定接受原位心脏移植的患者中急性移植物排斥反应与心电图变化之间的关系。

方法

研究人群包括 220 名接受心脏移植并参与 NEW HEART 研究的成年患者。分析心内膜心肌活检后 72 小时内获得的心电图；排除移植手术后 10 天内获得的心电图。使用包括排斥严重程度（轻度和中度/重度）和独立于排斥状态的时间趋势的重复测量分析进行统计模型分析。

结果

151 名男性和 69 名女性移植受者（平均年龄[标准差]，54[13]岁）有 969 对活检/心电图：677 对无排斥，280 对轻度排斥，12 对中度/重度排斥。中度至重度器官排斥与 QRS 持续时间显著增加（<0.001）、QT（=0.009）、QTc（=0.003）和 PR 间隔（=0.03）以及右束支阻滞分支（=0.002）和束支阻滞（=0.009）的发生几率增加相关。