Natural History of Left Ventricular Mechanics in Transplanted Hearts Relationships With Clinical Variables and Genetic Expression Profiles of Allograft Rejection
Natural History of Left Ventricular Mechanics in Transplanted Hearts Relationships With Clinical Variables and Genetic Expression Profiles of Allograft Rejection
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DOI：
10.1016/j.jcmg.2010.07.009
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发表时间：
2010-10-01
影响因子：
14
通讯作者：
Sengupta, Partho P.
中科院分区：
文献类型：
--
作者：
Eleid, Mackram F.;Caracciolo, Giuseppe;Sengupta, Partho P.
目的：本研究的目的是探讨左心室（LV）力学的时间演化与临床变量和基因表达谱的关系，这些变量和基因表达谱与心脏移植功能有关。背景：关于移植心脏左室收缩性能（TXH）变异性的范围和决定因素存在相当大的不确定性。方法51例患者（平均年龄53±12岁；男性37例）在移植后2周、3、6、12和24个月接受超声心动图、心导管检查、基因表达谱和心内膜活检数据的系列评估。比较TXH患者与37例对照组（包括12例冠状动脉搭桥术后患者）的二维斑点跟踪数据。移植后死亡率和住院率记录，中位随访时间为944天。结果TXH患者的整体纵向应变（LS）和径向应变在所有时间点均保持减弱（p < 0.001和p = 0.005），与临床排斥事件无关。未能在3个月时改善总体LS （>= 1 SD）与较高的死亡和心脏事件发生率相关（风险比：5.92；95%可信区间：1.96至17.91;p = 0.049）。多因素分析显示，基因表达评分是全球LS的唯一独立预测因子（r -2 = 0.53, p = 0.005），其中SEMA7A基因表达与全球LS相关性最高（r = -0.84, p < 0.001）。结论斑点追踪衍生的左室毒株有助于估计TXH患者左室功能障碍的负担，这种负担与活检检测到的细胞排斥反应无关。移植后3个月未能改善总体LS与较高的死亡和心脏事件发生率相关。左室力学的一系列变化与外周血基因表达谱相关，可能影响TXH患者长期预后的临床评估。[J]中华医学会心脏科杂志2010；3:989-1000
OBJECTIVES The aim of this study was to explore the temporal evolution of left ventricular (LV) mechanics in relation to clinical variables and genetic expression profiles implicated in cardiac allograft function.BACKGROUND Considerable uncertainty exists regarding the range and determinants of variability in LV systolic performance in transplanted hearts (TXH).METHODS Fifty-one patients (mean age 53 +/- 12 years; 37 men) underwent serial assessment of echocardiograms, cardiac catheterization, gene expression profiles, and endomyocardial biopsy data within 2 weeks and at 3, 6, 12, and 24 months after transplantation. Two-dimensional speckle-tracking data were compared between patients with TXH and 37 controls (including 12 post-coronary artery bypass patients). Post-transplantation mortality and hospitalizations were recorded with a median follow-up period of 944 days.RESULTS Global longitudinal strain (LS) and radial strain remained attenuated in patients with TXH at all time points (p < 0.001 and p = 0.005), independent of clinical rejection episodes. Failure to improve global LS at 3 months (>= 1 SD) was associated with higher incidence of death and cardiac events (hazard ratio: 5.92; 95% confidence interval: 1.96 to 17.91; p = 0.049). Multivariate analysis revealed gene expression score as the only independent predictor of global LS (R-2 = 0.53, p = 0.005), with SEMA7A gene expression having the highest correlation with global LS (r = -0.84, p < 0.001).CONCLUSIONS Speckle tracking-derived LV strains are helpful in estimating the burden of LV dysfunction in patients with TXH that evolves independent of biopsy-detected cellular rejection. Failure to improve global LS at 3 months after transplantation is associated with a higher incidence of death and cardiac events. Serial changes in LV mechanics correlate with peripheral blood gene expression profiles and may affect the clinical assessment of long-term prognosis in patients with TXH. (J Am Coll Cardiol lmg 2010;3:989-1000) (C) 2010 by the American College of Cardiology Foundation