Grauhan O, Müller J, Knosalla C, Pfitzmann R, Cohnert T, Siniawski H, Volk H D, Fietze E, Hetzer R
Deutsches Herzzentrum, Berlin.
Z Kardiol. 1996 Oct;85(10):745-52.
Measuring intramyocardial ECG amplitude is a clinical non-invasive procedure used for diagnosing rejection after heart transplantation. In recent years, as the importance of humoral mediated rejection has increasingly been recognized, the fact that endomyocardial biopsies often produce false negative results due to the absence of lymphocytic infiltrates has become a matter of concern. In order to test the reliability of IMEG diagnosis of this form of rejection, heterotopic neck-heart transplantation was performed on eight beagles which were previously sensitized through several skin transplantations. Over the course of the study IMEG registrations were performed daily as well as echocardiographic examinations to determine left ventricular wall thickness and maximal diastolic relaxation velocity. Donor-specific antibodies in serum (IgG, IgM) were also determined daily. Myocardial biopsies, performed once every 2 days, were examined for the presence of edema and lymphocytic infiltrate (according to the guidelines of the International Society of Heart and Lung Transplantation, ISHLT) and examined under immunofluorescent microscopy of IgG and IgM. Under triple drug immunosuppression with cyclosporine A, azathioprine, and cortisone accelerated rejection occurred on the fifth postoperative day (range: 4th-5th). All eight episodes were detected through IMEG diagnosis (sensitivity 100%), while the myocardial biopsies graded according to ISHLT guidelines indicated only one case of relevant lymphocytic infiltrate (Grade 3A) (sensitivity 12.5%). In each case rejection was recognized so early that it was possible to perform therapy with restitutio ad integrum. This proved that, as opposed to endomyocardial biopsy, IMEG diagnosis detected humoral mediated rejection early and with high reliability. Furthermore, the immediate recovery in IMEG during therapy indicates that the voltage decrease cause by rejection cannot be explained by an irreversible loss of myocardium (myocytolysis), but rather may be due to a quickly reversible functional impairment.
测量心肌内心电图幅度是一种用于诊断心脏移植术后排斥反应的临床无创检查方法。近年来，随着体液介导的排斥反应的重要性日益得到认可，由于缺乏淋巴细胞浸润，心内膜活检常产生假阴性结果这一事实已成为人们关注的问题。为了测试心肌内心电图幅度（IMEG）诊断这种排斥反应形式的可靠性，对8只先前通过多次皮肤移植致敏的比格犬进行了异位颈部-心脏移植。在研究过程中，每天进行IMEG记录以及超声心动图检查，以确定左心室壁厚度和最大舒张期松弛速度。每天还测定血清中的供体特异性抗体（IgG、IgM）。每2天进行一次心肌活检，检查是否存在水肿和淋巴细胞浸润（根据国际心肺移植学会，ISHLT的指南），并在免疫荧光显微镜下检查IgG和IgM。在使用环孢素A、硫唑嘌呤和可的松进行三联药物免疫抑制的情况下，加速排斥反应发生在术后第5天（范围：第4 - 5天）。所有8次发作均通过IMEG诊断检测到（敏感性100%），而根据ISHLT指南分级的心肌活检仅显示1例相关淋巴细胞浸润（3A级）（敏感性12.5%）。在每种情况下，排斥反应都被早期识别，以至于能够进行完全恢复的治疗。这证明，与心内膜活检不同，IMEG诊断能够早期且高度可靠地检测到体液介导的排斥反应。此外，治疗期间IMEG的立即恢复表明，排斥反应导致的电压降低不能用心肌不可逆损失（心肌溶解）来解释，而可能是由于快速可逆的功能损害。
