Back to ECG in Predicting Graft Dysfunction in the Era of Molecular Assays: Einthoven's Revenge?

Purpose Little is known about the role of ECG in heart transplanted (HT) patients (pts). In this study, we sought to identify ECG parameters that could help to identify graft dysfunction and to stratify prognosis. Methods Pts enrolled in a prospective study aimed to test a novel immune monitoring test (Quantiferon monitor), consecutively coming at our Clinic (2014-17) constituted study cohort. We created 3 groups: A) normal graft function (HT 5 yrs); C) LVEF Results Among 153 pts (58±14 yrs, 75%M), 79% had normal graft function (51% A, 28% B). Pts with graft dysfunction (21%), compared with groups A and B respectively, had a different distance from HT (1.2±1.6 vs 15.7±5.7 vs 12.9±7.4 yrs), more frequently CAV (8.8% vs 14.9% vs 64%), longer PQ (181±53 vs 163±38 vs 148±25 ms), wider QRS (131±34 vs 105±18 vs 101±18 ms), longer QTc (473±5 vs 445±4 vs 453±3 ms), more conduction disorders (75% vs 51.2% vs 39.2%) and Afib (9.1% vs 0 vs 4.6%), p≤ 0.01 for all; heart rate was intermediate between A and B. Distance from HT (i.e. >5yrs) and, similarly, CAV, carried a longer PQ, wider QRS, more conduction disturbances (p Conclusion ECG parameters in HT are influenced by many factors, reflecting multiple pathways leading to graft dysfunction. QTc may be a marker of subclinical systolic dysfunction (i.e. microvascular disease, chronic rejection) and help in identifying high risk pts.