Prognostic Utility of Right Ventricular Free Wall Strain in Low Risk Patients After Orthotopic Heart Transplantation
Prognostic Utility of Right Ventricular Free Wall Strain in Low Risk Patients After Orthotopic Heart Transplantation
复制标题
DOI：
10.1016/j.amjcard.2017.03.003
复制
发表时间：
2017-06-01
影响因子：
2.8
通讯作者：
Desai, Milind Y.
中科院分区：
文献类型：
--
作者：
Barakat, Amr F.;Sperry, Brett W.;Desai, Milind Y.
斑点追踪超声心动图的整体纵向应变（GLS）是在明显收缩功能障碍发作前检测局部左、右心室（LV和RV）功能障碍的敏感指标。我们试图评估原位心脏移植（OHT）后1年时测量低风险患者的LV-GLS和RV游离壁应变（FWS）的预后效用。我们回顾性研究了96名OHT受者（年龄52 - 14岁，64%为男性）在移植后1年无抗体介导的排斥反应或中度至重度冠状动脉同种异体移植物血管病变（CAV，2 - 3级）。使用EchoPAC软件计算LV-GLS和RV-FWS。考克斯模型是在调整心脏移植后死亡率预测指数（IMPACT）评分（移植后风险评分）后开发的，主要结局为死亡、中度至重度CAV或经治疗的排斥反应。术后1年左室射血分数和右室面积变化分数分别为58.7%和42.10%。LV-GLS为17.0 ± 3.3%，RV-FWS为16.4 ± 4.5%。平均随访4.5年，28例患者达到主要终点（10例死亡，5例血管病变，17例排斥反应）。在序贯考克斯模型中，RV功能标志物与主要结局相关（RV-FAC，p = 0.012; RV-FWS，p = 0.022），而LV射血分数和LV-GLS则无关。我们得出结论，在低风险患者OHT后1年，RV功能标志物（RV-FAC和RV-FWS）与排斥反应、CAV和死亡独立相关。RV功能障碍的标志物可能被纳入风险评分和未来的前瞻性研究中，以对OHT后的患者进行风险分层。(C)2017由Elsevier Inc.出版
Global longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive measure of regional left and right ventricular (LV and RV) dysfunction, before onset of overt systolic dysfunction. We sought to evaluate the prognostic utility of measuring LV-GLS and " RV free wall strain (FWS) in low risk patients at 1 year after orthotopic heart transplantation (OHT). We retrospectively studied 96 OHT recipients (age 52 14 years, 64% men) free of antibody-mediated rejection or moderate to severe coronary allograft vasculOpathy (CAV, grade 2 to 3) at 1 year after transplant. LV-GLS and RV-FWS were calculated using EchoPAC software. Cox models were developed after adjusting for the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score (post-transplant risk score), with the primary outcome of death, moderate to severe CAV, or treated rejection. At 1 year after transplant, LV ejection fraction and RV fractional area change (FAC) were 58 7% and 42 10%, respectively. LV-GLS was 17.0 3.3% and RV-FWS 16.4 4.5%. At an average follow-up of 4.5 years, 28 patients met the primary end point (10 death, 5 vasculopathy, 17 rejection). In sequential Cox models, markers of RV function were associated with the primary outcome (RV-FAC, p = 0.012; RV-FWS, p = 0.022), while LV ejection fraction and LV-GLS were not. We conclude that in low risk patients 1 year after OHT, markers of RV function (RV-FAC and RV-FWS) are independently associated with incident rejection, CAV, and death. Markers of RV dysfunction could potentially be incorporated into risk scores and future prospective studies to risk stratify patients after OHT. (C) 2017 Published by Elsevier Inc.