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Tian D, Huang H, Wen HY. Noninvasive methods for detection of chronic lung allograft dysfunction in lung transplantation. Transplant Rev (Orlando) 2020; 34:100547. [PMID: 32498976 DOI: 10.1016/j.trre.2020.100547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/15/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023]
Abstract
Lung transplantation (LTx) is the only therapeutic option for end-stage lung diseases. Chronic lung allograft dysfunction (CLAD), which manifests as airflow restriction and/or obstruction, is the primary factor limiting the long-term survival of patients after surgery. According to histopathological and radiographic findings, CLAD comprises two phenotypes, bronchiolitis obliterans syndrome and restrictive allograft syndrome. Half of all lung recipients will develop CLAD in 5 years, and this rate may increase up to 75% 10 years after surgery owing to the paucity in accurate and effective early detection and treatment methods. Recently, many studies have presented noninvasive methods for detecting CLAD and improving diagnosis and intervention. However, the significance of accurately detecting CLAD remains controversial. We reviewed published studies that have presented noninvasive methods for detecting CLAD to highlight the current knowledge on clinical symptoms, spirometry, imaging examinations, and other methods to detect the disease.
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Affiliation(s)
- Dong Tian
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu, China.
| | - Heng Huang
- Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hong-Ying Wen
- Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Watson AM, Bhutiani N, Philips P, Davis EG, Eng M, Cannon RM, Jones CM. The role of FDG-PET in detecting rejection after liver transplantation. Surgery 2018; 164:257-261. [DOI: 10.1016/j.surg.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 01/20/2023]
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McDiarmid AK, Plein S, Ross HJ. Emerging imaging techniques after cardiac transplantation. J Heart Lung Transplant 2016; 35:1399-1411. [PMID: 27523792 DOI: 10.1016/j.healun.2016.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022] Open
Abstract
Improvements in survival after cardiac transplantation have in part been driven by improved graft surveillance. Graft surveillance relies mainly on 3 techniques: coronary angiography, endomyocardial biopsy and echocardiography. Developments in invasive and non-invasive imaging technology have revolutionized assessment of the heart in both health and disease, offering new insights into tissue composition and myocardial metabolism. Herein we aim to review the strengths and weaknesses of these techniques, and summarize the evidence in the following 5 fields of cardiac imaging after transplantation: cardiovascular magnetic resonance; computed tomography; positron emission tomography; single-photon emission computed tomography; and optical coherence tomography and molecular imaging techniques.
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Affiliation(s)
- Adam K McDiarmid
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Heather J Ross
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Use of [18F]FDG Positron Emission Tomography to Monitor the Development of Cardiac Allograft Rejection. Transplantation 2015; 99:e132-9. [PMID: 25675207 DOI: 10.1097/tp.0000000000000618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positron emission tomography (PET) has the potential to be a specific, sensitive and quantitative diagnostic test for transplant rejection. To test this hypothesis, we evaluated F-labeled fluorodeoxyglucose ([F]FDG) and N-labeled ammonia ([N]NH3) small animal PET imaging in a well-established murine cardiac rejection model. METHODS Heterotopic transplants were performed using minor major histocompatibility complex-mismatched B6.C-H2 donor hearts in C57BL/6(H-2) recipients. C57BL/6 donor hearts into C57BL/6 recipients served as isograft controls. [F]FDG PET imaging was performed weekly between posttransplant days 7 and 42, and the percent injected dose was computed for each graft. [N]NH3 imaging was performed to evaluate myocardial perfusion. RESULTS There was a significant increase in [F]FDG uptake in allografts from day 14 to day 21 (1.6% to 5.2%; P < 0.001) and uptake in allografts was significantly increased on posttransplant days 21 (5.2% vs 0.9%; P = 0.005) and 28 (4.8% vs 0.9%; P = 0.006) compared to isograft controls. Furthermore, [F]FDG uptake correlated with an increase in rejection grade within allografts between days 14 and 28 after transplantation. Finally, the uptake of [N]NH3 was significantly lower relative to the native heart in allografts with chronic vasculopathy compared to isograft controls on day 28 (P = 0.01). CONCLUSIONS PET imaging with [F]FDG can be used after transplantation to monitor the evolution of rejection. Decreased uptake of [N]NH3 in rejecting allografts may be reflective of decreased myocardial blood flow. These data suggest that combined [F]FDG and [N]NH3 PET imaging could be used as a noninvasive, quantitative technique for serial monitoring of allograft rejection and has potential application in human transplant recipients.
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Lu W, Zheng J, Pan XD, Li B, Zhang JW, Wang LF, Sun LZ. A new simplified volume-loaded heterotopic rabbit heart transplant model with improved techniques and a standard operating procedure. J Thorac Dis 2015; 7:653-61. [PMID: 25973231 DOI: 10.3978/j.issn.2072-1439.2015.03.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The classic non-working (NW) heterotopic heart transplant (HTX) model in rodents had been widely used for researches related to immunology, graft rejection, evaluation of immunosuppressive therapies and organ preservation. But unloaded models are considered not suitable for some researches. Accordingly, We have constructed a volume-loaded (VL) model by a new and simple technique. METHODS Thirty male New Zealand White rabbits were randomly divided into two groups, group NW with 14 rabbits and group VL with 16 rabbits, which served as donors and recipients. We created a large and nonrestrictive shunt to provide left heart a sufficient preload. The donor superior vena cave and ascending aorta (AO) were anastomosed to the recipient abdominal aorta (AAO) and inferior vena cava (IVC), respectively. RESULTS No animals suffered from paralysis, pneumonia and lethal bleeding. Recipients' mortality and morbidity were 6.7% (1/15) and 13.3% (2/15), respectively. The cold ischemia time in group VL is slight longer than that in group NW. The maximal aortic velocity (MAV) of donor heart was approximately equivalent to half that of native heart in group VL. Moreover, the similar result was achieved in the parameter of late diastolic mitral inflow velocity between donor heart and native heart in group VL. The echocardiography (ECHO) showed a bidirectional flow in donor SVC of VL model, inflow during diastole and outflow during systole. PET-CT imaging showed the standard uptake value (SUV) of allograft was equal to that of native heart in both groups on the postoperative day 3. CONCLUSIONS We have developed a new VL model in rabbits, which imitates a native heart hemodynamically while only requiring a minor additional procedure. Surgical technique is simple compared with currently used HTX models. We also developed a standard operating procedure that significantly improved graft and recipient survival rate. This study may be useful for investigations in transplantation in which a working model is required.
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Affiliation(s)
- Wei Lu
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jun Zheng
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xu-Dong Pan
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Bing Li
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jin-Wei Zhang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Long-Fei Wang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li-Zhong Sun
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Pediatric Heart center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Sun H, Yang G, Liang T, Zhang C, Song J, Han J, Hou G. Non-invasive imaging of allogeneic transplanted skin graft by 131I-anti-TLR5 mAb. J Cell Mol Med 2014; 18:2437-44. [PMID: 25283154 PMCID: PMC4302649 DOI: 10.1111/jcmm.12423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/13/2014] [Indexed: 12/12/2022] Open
Abstract
Although 18F-fluorodeoxyglucose (18F-FDG) uptake can be used for the non-invasive detection and monitoring of allograft rejection by activated leucocytes, this non-specific accumulation is easily impaired by immunosuppressants. Our aim was to evaluate a 131I-radiolabelled anti-Toll-like receptor 5 (TLR5) mAb for non-invasive in vivo graft visualization and quantification in allogeneic transplantation mice model, compared with the non-specific radiotracer 18F-FDG under using of immunosuppressant. Labelling, binding, and stability studies were performed. BALB/c mice transplanted with C57BL/6 skin grafts, with or without rapamycin treatment (named as allo-treated group or allo-rejection group), were injected with 131I-anti-TLR5 mAb, 18F-FDG, or mouse isotype 131I-IgG, respectively. Whole-body phosphor-autoradiography and ex vivo biodistribution studies were obtained. Whole-body phosphor-autoradiography showed 131I-anti-TLR5 mAb uptake into organs that were well perfused with blood at 1 hr and showed clear graft images from 12 hrs onwards. The 131I-anti-TLR5 mAb had significantly higher graft uptake and target-to-non-target ratio in the allo-treated group, as determined by semi-quantification of phosphor-autoradiography images; these results were consistent with ex vivo biodistribution studies. However, high 18F-FDG uptake was not observed in the allo-treated group. The highest allograft-skin-to-native-skin ratio (A:N) of 131I-anti-TLR5 mAb uptake was significantly higher than the ratio for 18F-FDG (7.68 versus 1.16, respectively). 131I-anti-TLR5 mAb uptake in the grafts significantly correlated with TLR5 expression in the allograft area. The accumulation of 131I-IgG was comparable in both groups. We conclude that radiolabelled anti-TLR5 mAb is capable of detecting allograft with high target specificity after treatment with the immunosuppressive drug rapamycin.
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Affiliation(s)
- Hukui Sun
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong University, Ji'nan, Shandong, China
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7
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Chen DL, Wang X, Yamamoto S, Carpenter D, Engle JT, Li W, Lin X, Kreisel D, Krupnick AS, Huang HJ, Gelman AE. Increased T cell glucose uptake reflects acute rejection in lung grafts. Am J Transplant 2013; 13:2540-9. [PMID: 23927673 PMCID: PMC3956601 DOI: 10.1111/ajt.12389] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/30/2013] [Accepted: 06/15/2013] [Indexed: 01/25/2023]
Abstract
Although T cells are required for acute lung rejection, other graft-infiltrating cells such as neutrophils accumulate in allografts and are also high glucose utilizers. Positron emission tomography (PET) with the glucose probe [(18)F]fluorodeoxyglucose ([(18)F]FDG) has been employed to image solid organ acute rejection, but the sources of glucose utilization remain undefined. Using a mouse model of orthotopic lung transplantation, we analyzed glucose probe uptake in the grafts of syngeneic and allogeneic recipients with or without immunosuppression treatment. Pulmonary microPET scans demonstrated significantly higher [(18)F]FDG uptake in rejecting allografts when compared to transplanted lungs of either immunosuppressed or syngeneic recipients. [(18)F]FDG uptake was also markedly attenuated following T cell depletion therapy in lung recipients with ongoing acute rejection. Flow cytometric analysis using the fluorescent deoxyglucose analog 2-NBDG revealed that T cells, and in particular CD8(+) T cells, were the largest glucose utilizers in acutely rejecting lung grafts followed by neutrophils and antigen-presenting cells. These data indicate that imaging modalities tailored toward assessing T cell metabolism may be useful in identifying acute rejection in lung recipients.
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Affiliation(s)
- Delphine L. Chen
- Department of Radiology, Washington University School of Medicine,
St. Louis, MO 63110 USA,Address correspondence to either: Delphine L. Chen, Division of
Radiological Sciences and Nuclear Medicine, Washington University School of
Medicine, Box 8223, 510 S. Kingshighway Blvd., St. Louis, MO 63110
or Andrew E. Gelman, Division of
Cardiothoracic Surgery, Washington University School of Medicine, Box 8234, 660
S. Euclid Ave., St. Louis, MO 63110
| | - Xingan Wang
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Sumiharu Yamamoto
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Danielle Carpenter
- Department of Pathology & Immunology, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Jacquelyn T. Engle
- Department of Radiology, Washington University School of Medicine,
St. Louis, MO 63110 USA
| | - Wenjun Li
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Xue Lin
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA,Department of Pathology & Immunology, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Alexander S. Krupnick
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Howard J. Huang
- Department of Medicine, Washington University School of Medicine,
St. Louis, MO 63110 USA
| | - Andrew E. Gelman
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA,Department of Pathology & Immunology, Washington University
School of Medicine, St. Louis, MO 63110 USA,Address correspondence to either: Delphine L. Chen, Division of
Radiological Sciences and Nuclear Medicine, Washington University School of
Medicine, Box 8223, 510 S. Kingshighway Blvd., St. Louis, MO 63110
or Andrew E. Gelman, Division of
Cardiothoracic Surgery, Washington University School of Medicine, Box 8234, 660
S. Euclid Ave., St. Louis, MO 63110
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Kown MH, Strauss HW, Blankenberg FG, Berry GJ, Stafford-Cecil S, Tait JF, Goris ML, Robbins RC. In vivo imaging of acute cardiac rejection in human patients using (99m)technetium labeled annexin V. Am J Transplant 2001; 1:270-7. [PMID: 12102261 DOI: 10.1034/j.1600-6143.2001.001003270.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Annexin V binds phosphatidylserine moieties on apoptotic cells. This study reports the initial experience at Stanford University Medical Center with 99mTc-labeled annexin V imaging as a noninvasive measure of apoptosis in acute cardiac rejection. Ten cardiac transplant patients had 99mTc Annexin V imaging and endomyocardial biopsy (EMB) performed within 24 h. No complications related to 99mTc annexin V administration occurred. Eight patients had ISHLT grade of acute rejection of 1A or less. Five patients had two or more areas of uptake noted in the right ventricle on imaging studies. Two of these patients had positive biopsies: one patient had grade 2 rejection with two focal uptake areas and another had grade 3A rejection with three foci. An additional five patients had either one or zero hot spot areas and corresponding negative EMBs. 99mTc-annexin V appears to be well tolerated and may identify patients with acute cardiac rejection.
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Affiliation(s)
- M H Kown
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA 94305-5247, USA
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Heelan BT, Osman S, Blyth A, Schnorr L, Jones T, George AJ. Use of 2-[18F]fluoro-2-deoxyglucose as a potential agent in the prediction of graft rejection by positron emission tomography. Transplantation 1998; 66:1101-3. [PMID: 9808498 DOI: 10.1097/00007890-199810270-00022] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We investigated the potential of predicting allograft rejection by measuring the ability of graft-infiltrating cells to take up 2-[18F]fluoro-2-deoxyglucose ([18F]FDG). This molecule is a positron emitting glucose analogue that is taken up by metabolically active cells and can be detected using positron emission tomography. METHODS Uptake of [18F]FDG during an alloresponse was measured both in vitro in mixed lymphocyte cultures and in vivo using allogeneic and syngeneic skin grafts. RESULTS Uptake of [18F]FDG was seen in a mixed lymphocyte reaction. Using a mouse skin graft model, we found that mean [18F]FDG uptake was 1.5-2 times higher in allografts than in syngeneic grafts; the increase in uptake correlated with the level of T-cell infiltrate seen histologically. CONCLUSION Assessing the metabolic activity of graft-infiltrating cells with [18F]FDG may be useful in the prediction of graft rejection episodes.
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Affiliation(s)
- B T Heelan
- Department of Immunology, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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Klima U, Guerrero JL, Levine RA, Vlahakes GJ. A new, biventricular working heterotopic heart transplant model: anatomic and physiologic considerations. Transplantation 1997; 64:215-22. [PMID: 9256176 DOI: 10.1097/00007890-199707270-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Current heterotopic heart transplant models have nonworking left ventricles that atrophy and are not suitable for some studies. We developed and characterized a new heterotopic model with working left and right ventricles. METHODS Hemodynamics were compared in the working and nonworking models. The influence of the length of the donor's aorta on coronary arterial oxygenation was tested. The influence of the recipient's arterial pressure on developed left ventricular systolic pressure and the effects of alpha- and beta-adrenergic stimulation were examined in both models. The nonworking and working models were compared in chronic transplant preparations to investigate possible ventricular atrophy. RESULTS In this model, coronary arterial oxygen tension was influenced by the length of the donor's aorta. With a short donor aorta (0.5 cm in the porcine model), normal coronary arterial oxygenation is maintained. Left ventricular systolic pressure was greater in the working compared with the nonworking models. Left ventricular systolic pressure did not respond to alpha-adrenergic stimulation but did respond to beta-adrenergic and combined stimulation, which indicates its relationship to donor heart output. Left ventricular systolic pressure correlated with and was determined by recipient arterial pressure. Ventricular atrophy occurred in the nonworking model, but ventricular weight was maintained at sham control levels in this new working model. CONCLUSION These results demonstrate the surgical anatomic considerations of a new heterotopic heart transplant model in which the left and right ventricles work. Its hemodynamic performance is related to recipient hemodynamics, and the model responds to adrenergic stimulation. In chronic studies, ventricular mass is maintained, thus allowing this model to overcome a significant shortcoming of existing heterotopic heart transplant models.
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Affiliation(s)
- U Klima
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114-2696, USA
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Everett JE, Palmer MN, Jessurun J, Shumway SJ. Noninvasive diagnosis of cardiac allograft rejection in an orthotopic canine model. Ann Thorac Surg 1996; 62:1337-40; discussion 1340-1. [PMID: 8893565 DOI: 10.1016/0003-4975(96)00570-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND A decline in the R wave voltage obtained from surface electrocardiograms once correlated with cardiac allograft rejection. With cyclosporine therapy, however, these electrocardiographic findings became inconsistent, occurring only during severe rejection episodes. Despite cyclosporine use, intramyocardial unipolar peak-to-peak amplitudes obtained from plunge electrodes are reported to be highly sensitive and specific for diagnosing rejection. These reports are based on heterotopic grafts, which atrophy over time, making long-term voltage changes during rejection difficult to interpret. The purpose of this study was to use analysis of unipolar peak-to-peak amplitudes as a prospective monitoring tool for diagnosing orthotopic cardiac allograft rejection. METHODS Ten adult mongrel dogs underwent orthotopic heart transplantation with the attachment of four intramyocardial leads. The unipolar peak-to-peak amplitudes were measured daily and compared with endomyocardial biopsy results. RESULTS We found that intramyocardial unipolar peak-to-peak amplitude analysis had a sensitivity and a specificity of 100% for diagnosing rejection. We also found that as the number of myocardial leads increased, the sensitivity of detecting rejection also increased. CONCLUSIONS We conclude that unipolar peak-to-peak amplitude analysis is an accurate noninvasive means for early detection of cardiac allograft rejection in an orthotopic model. Its success should allow less frequent, more selective use of endomyocardial biopsy.
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Affiliation(s)
- J E Everett
- Department of Surgery, University of Minnesota, Minneapolis, USA
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12
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Everett JE, Irwin E, Jesserun J, Slovut D, Shumway SJ. Noninvasive diagnosis of cardiac allograft rejection: the effect of procainamide. J INVEST SURG 1995; 8:195-201. [PMID: 7547727 DOI: 10.3109/08941939509023142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The surface electrocardiogram (ECG) has been used as a noninvasive technique for the diagnosis of cardiac allograft rejection. Alteration in conduction, R-wave amplitude, and rhythm have been associated with rejection. These ECG findings are modulated by the myocyte sodium channel, but are inconsistent and occur only during severe rejection episodes. The purpose of this study was to (1) characterize changes in cardiac electrophysiology during allograft rejection using the highly sensitive intramyocardial electrocardiogram and (2) determine whether pharmacological sodium channel blockade with procainamide enhances subtle ECG changes. Nine mongrel dogs underwent heterotopic heart transplantation in which four intramyocardial leads (one anteriorly and posteriorly on each ventricle) were attached. Leads exited to a subcutaneously placed ECG block which was transcutaneously accessed posttransplant to record direct intramyocardial electrocardiograms. Six animals were treated with procainamide, while three were not and served as controls. Daily measurements included the QRS, QT, and QTc intervals and the R-wave amplitude. Endomyocardial biopsies were performed weekly and also when significant decline in ECG amplitude occurred. Detailed ECG interval analysis failed to establish any correlation between conduction and rejection, even in the procainamide-treated group. Intramyocardial amplitude analysis, however, had a sensitivity of 100% and a specificity of 86% for the diagnosis of rejection. The results indicate that intramyocardial ECG interval analysis is not predictive of rejection even when prolonging conduction with procainamide. Amplitude analysis, however, remains an accurate noninvasive means for the early detection of cardiac allograft rejection and should allow more selective use of endomyocardial biopsy.
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Affiliation(s)
- J E Everett
- Department of Surgery, University of Minnesota, Minneapolis, USA
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