Warnecke H, Schüler S, Goetze H J, Matheis G, Süthoff U, Müller J, Tietze U, Hetzer R
Circulation. 1986 Nov;74(5 Pt 2):III72-6.
Rejection after cardiac transplantation was monitored in nine patients by control of intramyocardial electrogram (IMEG) recordings transmitted by an implanted telemetric pacemaker. Under immunosuppression with cyclosporin A and prednisolone, 33 out of a total of 119 endomyocardial biopsy specimens showed moderate rejection (infiltrate with myocytolysis). Twenty-nine of these rejection episodes could be correctly predicted from IMEG recordings with a voltage drop above 15% used as a criterion (sensitivity 87.9%). Eighty-three of 86 negative biopsy results corresponded to negative IMEG results (specificity 96.5%). In this group of patients, amplitude of body surface electrocardiograms was not useful for the diagnosis of rejection because of the broad range of spontaneous variation. Control of IMEG voltage amplitude appears to be more accurate than body surface electrocardiogram amplitude in the detection of rejection episodes. Thus the onset of rejection during biopsy intervals is more readily detected and treatment is instituted earlier. The method is suitable for ambulatory patient monitoring by the patient's local physician.
通过植入式遥测起搏器传输的心肌电图（IMEG）记录对9例心脏移植患者的排斥反应进行监测。在使用环孢素A和泼尼松龙进行免疫抑制的情况下，119份心内膜活检标本中共有33份显示中度排斥反应（伴有肌细胞溶解的浸润）。其中29次排斥反应发作可根据IMEG记录正确预测，以电压下降超过15%作为标准（敏感性87.9%）。86份活检阴性结果中的83份与IMEG阴性结果相符（特异性96.5%）。在这组患者中，由于体表心电图的自发变化范围广泛，其振幅对排斥反应的诊断没有帮助。在检测排斥反应发作方面，控制IMEG电压振幅似乎比体表心电图振幅更准确。因此，在活检间隔期间排斥反应的发作更容易被检测到，并且治疗可以更早开始。该方法适用于由患者的当地医生对门诊患者进行监测。
