Prognostic Value of Left and right ventricular deformation strain analysis on Acute Cellular rejection in Heart Transplant recipients: A 6-year outcome study.
Prognostic Value of Left and right ventricular deformation strain analysis on Acute Cellular rejection in Heart Transplant recipients: A 6-year outcome study.
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DOI：
10.1007/s10554-022-02586-z
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发表时间：
2022-11
影响因子：
2.1
通讯作者：
Chan, Jonathan
中科院分区：
文献类型：
--
作者：
Chamberlain, Robert;Edwards, Natalie F. A.;Doyle, Samantha N.;Wong, Yee Weng;Scalia, Gregory M.;Sabapathy, Surendran;Chan, Jonathan
二维应变分析是一种检测移植术后急性细胞排斥反应（ACR）心肌功能障碍的灵敏方法。本研究旨在评估移植后1年与ACR负担相关的预后风险分层中新型左（LV）和右心室（RV）应变参数的效用。128名心脏移植患者在2012年至2018年间接受了经胸超声心动图检查和心内膜心肌活检。进行二维应变分析，并根据移植后1年的ACR负荷评估排斥负荷史并进行分组。主要终点是6年随访时的全因死亡率。21例患者达到主要终点。6年全因死亡率的多因素分析显示，左室总纵向应变（LV GLS）（危险比[HR] = 1.21, CI = 1.06-1.49）、左室舒张早期应变率（LV ESr） （HR = 1.31, CI = 1.12 - 1.54）、左室GLS （HR = 1.12, CI = 1.02-1.25）和左室ESr （HR = 1.26, CI = 1.12 - 1.47）是预后的显著预测因素。单因素分析还显示，LV GLS、LV ESr、RV GLS和RV ESr是预后的显著预测因子。通过接受手术者特征预测左室GLS患者6年死亡率的最佳截止值为15.5%（敏感性：92%，特异性：79%）。排斥反应组间左室GLS、左室GLS、左室ESr及左室ESr均显著降低（p < 0.05）。无创左室和右室菌株参数是移植后ACR患者死亡率的预测因子。左室GLS和左室ESr优于其他应变和常规回波参数。
Two-dimensional (2D) strain analysis is a sensitive method for detecting myocardial dysfunction in acute cellular rejection (ACR) from post-transplant complications. This study aims to evaluate the utility of novel left (LV) and right ventricular (RV) strain parameters for prognostic risk stratification associated with ACR burden at 1-year post transplantation. 128 Heart transplant patients, assessed between 2012 and 2018, underwent transthoracic echocardiography and endomyocardial biopsy. 2D strain analysis was performed and history of rejection burden was assessed and grouped according to ACR burden at 1-year post transplantation. The primary endpoint was all-cause mortality at 6-years follow up. 21 patients met primary the endpoint. Multivariate analysis of 6-year all-cause mortality showed LV global longitudinal strain (LV GLS) (Hazard Ratio [HR] = 1.21, CI = 1.06–1.49), LV early diastolic strain rate (LV ESr) (HR = 1.31, CI = 1.12–1.54), RV GLS (HR = 1.12, CI = 1.02–1.25) and RV ESr (HR = 1.26, CI = 1.12–1.47) were significant predictors of outcome. Univariate analysis also showed LV GLS, LV ESr, RV GLS and RV ESr were significant predictors of outcome. Optimal cut-off for predicting 6-year mortality for LV GLS by receive operator characteristic was 15.5% (sensitivity: 92%, specificity: 79%). Significant reductions (p < 0.05) in LV GLS, RV GLS and LV and RV ESr between rejection groups were seen. Non-invasive LV and RV strain parameters are predictors of mortality in post-transplant patient with ACR. LV GLS and LV ESr are superior to other strain and conventional echo parameters.
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影响因子：
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作者：
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通讯作者：
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Biering-Sorensen, Tor
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10.1016/j.echo.2017.11.003
发表时间：
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