ELECTROCARDIOGRAPHIC DETECTION OF ACUTE CARDIAC ALLOGRAFT-REJECTION

In order to evaluate the diagnostic value of standard-ECG (ST-ECG) and precordial mapping-ECG with 63 unipolar leads (PM-ECG) for detection of acute cardiac allograft rejection, 15 patients (12 male, 3 female; age range 24-64 years) were studied. ST-ECG and PM-ECG were recorded along with 94 endomyocardial biopsies. Twenty-four acute rejections were detected histologically. Using the ST-ECG, a reduction of the QRS-amplitude-sum (lead I, II, III, V1 and V6) greater-than-or-equal-to 5 % in comparison with the ECG obtained 1 week before was found to be the best diagnostic criterion (sensitivity 63 %, specificity 74 %, positive predictive value 48 %, negative predictive value 85 %). By analysing the PM-ECG a drop of the QRS-amplitude greater-than-or-equal-to 12 % in greater-than-or-equal-to 14/63 precordial leads was determined to be the most reliable parameter (sensitivity 79 %, specificity 71 %, positive predictive value 49 %, negative predictive value 91 %). In contrast to the high sensitivity of PM-ECG, ST-ECG was less suitable for detection of acute rejection. However, taking into account the high negative predictive value of PM-ECG, acute rejection could be excluded with high probability, if the QRS-amplitudes of the PM-ECG remained stable. This may lead to a lower frequency of routinely performed endomyocardial biopsies.