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Table 1 Human Studies on QT Interval Prolongation after Heart Transplantation

From: Remote noninvasive allograft rejection monitoring for heart transplant recipients: study protocol for the novel evaluation with home electrocardiogram and remote transmission (NEW HEART) study

# Subjects Author/Yr

Study Design

Major Findings

Study Limitations

Implications for NEW HEART Study

N = 65 Richartz et al. 1998 [8]

Prospective; Rejection during in-hospital period

1. Mean QTC = 449 ± 2 ms without rejection; 517 ± 11 ms with rejection (p < 0.001) 2. > 10% increase in QTC predicted rejection with sensitivity, 86%; specificity, 88%

1. Only observed rejection during hospitalization for transplant surgery 2. Analyzed only 3 ECGs per subject 3. ECG analyzers not blinded from clinical information about rejection

An increase in the QT interval predicts acute allograft rejection

N = 52 Kolasa et al. 2005 [9]

Retrospective; Long-term mortality over 7 yrs

Poorer survival over 7 yrs in subjects who had a > 10 ms per year change in their QTC interval on their annual ECG

1. Link to rejection not studied 2. Analyzed only one ECG per year

As little as a 10 ms change in the QT interval is linked to mortality

N = 200 Tenderich et al. 2006 [10]

Retrospective; Rejection during first 3 months

> 25 ms increase in QTC interval predicted acute allograft rejection with sensitivity, 77%; specificity, 96%.

1. Only analyzed 2 ECGs per subject 2. ECG analyzers not blinded from clinical information about rejection

Increase in QT interval predicts acute rejection during the period of interest

N = 587 Vrtovec et al. 2006 [11]

Retrospective; Long-term mortality up to 17 yrs

1. Patients with ≥ 10% increase in QTC interval between 1st and 2nd year post-transplant had 6.86 times higher risk of dying.2. ≥ 10% increase in QTC was the only independent predictor of long- term mortality on multivariate analysis 3. Trend was a decreasing QTC over the yrs suggesting sympathetic reinnervation

1. Link to rejection not studied 2. Analyzed only one ECG per year

An increase in the QT interval is linked to mortality

N = 71 Vrtovec et al. 2008 [12]

Retrospective; 1- year all-cause & SCD mortality in subjects with severe acute rejection

1. QTC was longer in SCD group than in survivors (475 ± 57 versus 437 ± 36 ms; p = 0.02) 2. Patients who had > 10% increase in QT interval during a severe acute rejection episode were at increased risk for SCD.

1. Limited to just patients with severe rejection; unable to tell whether increased QT interval could predict earlier, milder forms of rejection 2. Analyzed just 2 ECGs per subject (one at baseline 7 days after surgery, second at time of rejection)

An increase in the QT interval is linked to mortality

  1. ms = millisecond; SCD = sudden cardiac death; QTc = QT interval corrected for heart rate