Abstract 20822: Vector Predictors of Acute Moderate Cellular Rejection in Pediatric Heart Transplant Recipients
Introduction: Heart transplant has remained the gold-standard surgical approach to treatment of refractory heart failure. The incidence of graft rejection has been reported to be 25%, accounting for 10% of all post-transplant deaths. Endomyocardial biopsy (EMB) in the gold standard for detection of acute cellular rejection detection but is an invasive and costly procedure that is not without risk. Previous studies have shown that prolongation of the QT interval and qualitative decrease in QRS amplitude have been associated with rejection.
Hypothesis: We hypothesize the QRS vector magnitude based on a resting 12-lead ECG would have predictive value for EMB proven moderate or severe acute cellular rejection (ACR).
Methods: A blinded, retrospective evaluation of patients with available Biopsy data was performed between 1999 and 2010. Resting 12-lead ECG’s were performed on the day of biopsy. Two hundred and eight biopsies were in reviewed in 180 patients. Cardiomyopathy was the pre-transplant diagnosis in 108 patients (51.9%), congenital heart disease in 78 patients (37.5%) and repeat-OHT in 22 patients (10.6%). Measurements of the spatial QRS-T angle (degrees) by visually estimated Kors’ regression method and of the QRS vector magnitude (QRSVm, millivolts) as well as the QTc were assessed.
Results: Two hundred and eight biopsies were reviewed in 180 patients. The Mean age was 14.1.0 ± 5.2 years. Median time from transplant was 8 years (IQR 3.2-11.9). Fifty four percent of the patients were male. There were 72 (34.6%) cases with and 136 (65.4%) cases without moderate/severe ACR. The QRSVm significantly differentiated those with (1.16 ± 0.39) versus those without ACR (1.55 ± 0.61, p-value <0.001). At an optimum cut-off point of 1.76mV, the positive and negative predictive values for identification of ACR was 43.8% and 95.8%, respectively. The spatial QRS-T angle nor the QTc significantly differentiate those with ACR versus those without ACR.
Conclusions: The QRSVm identifies moderate/severe ACR in pediatric heart transplant recipients with high negative predictive value. If reproducible in future studies this may help to limit endomyocardial biopsies on patients not in ACR.
Author Disclosures: D. Cortez: None. N. Sharma: None. S. Auerbach: None.
- © 2016 by American Heart Association, Inc.