Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients
Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients
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DOI：
10.1016/j.ejcts.2009.11.037
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发表时间：
2010-05-01
影响因子：
3.4
通讯作者：
Komamura, Kazuo
中科院分区：
文献类型：
--
作者：
Kato, Tomoko-Sugiyama;Oda, Noboru;Komamura, Kazuo
目的：非侵入性诊断排斥反应是心脏移植受者治疗的主要目标。研究了超声心动图应变率（SR）成像检测心脏移植受者排斥反应的能力。方法：对35例心脏移植患者进行了396次心肌活检、右心导管检查和超声心动图检查。计算从8个左心室节段获得的收缩期应变（SYS）、收缩期峰值SR（SRsys）和舒张早期峰值SR（SRdia）的平均值。结果如下：根据传统的国际心肺移植学会标准，351例活检显示排斥反应等级（急性排斥反应，AR）为0或1a（AR（-）组），而45例活检显示等级为1b或更高（AR（+）组）。AR（+）组与AR（-）组之间的SRI（sys）、SRsys和SRdia有显著性差异（分别为-20.7 +/- 8.0 vs -32.6 +/-6.3%，p < 0.0001、2.5 +/- 1.8 vs 3.6 +/- 1.1/s，p < 0.0001和-1.9 +/- 1.6 vs -3.5 +/- 1.3/s，p < 0.001）。多变量分析确定AR（+）组的强预测因子为Rmax（sys）（p < 0.0001），Rmax（sys）临界值为-27.4%，预测准确率为82.3%。联合应用SRDIA（sys）和SRdia可区分AR（+）组和AR（-）组，预测准确率为84.8%。AR（+）组的肺动脉楔压高于AR（-）组（7.4 ± 3.0 vs 9.4 ± 4.4mmHg，p < 0.05）。结论：SR显像对心脏移植术后急性排斥反应的监测具有潜在的临床应用价值。(C)2009年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: Non-invasive diagnosis of rejection is a major objective in the management of heart transplant recipients. The ability of strain rate (SR) imaging on echocardiograms to detect rejection in heart transplant recipients was investigated. Methods: A total of 396 endomyocardial biopsies, right-heart catheterisation and echocardiograms were performed in 35 heart transplant recipients. Mean values of systolic strain (epsilon(sys)), peak systolic SR (SRsys), and peak early diastolic SR (SRdia) obtained from eight left ventricular segments were calculated. Results: According to the conventional International Society for Heart and Lung Transplantation criteria, 351 biopsies showed a rejection grade (acute rejection, AR) of 0 or 1a (group AR(-)) whereas 45 biopsies showed a grade of 1b or higher (group AR(+)). The epsilon(sys), SRsys and SRdia were significantly different between group AR(+) and group AR(-) (-20.7 +/- 8.0 vs -32.6 +/- 6.3%, p < 0.0001, 2.5 +/- 1.8 vs 3.6 +/- 1.1/s, p < 0.0001, and -1.9 +/- 1.6 vs -3.5 +/- 1.3/s, p < 0.001, respectively). Multivariate analysis identified epsilon(sys) (p < 0.0001) as a strong predictor for group AR(+), and epsilon(sys) cut-off value of -27.4% was associated with a predictive accuracy of 82.3%. The combination of epsilon(sys) and SRdia discriminated group AR(+) from group AR(-) with a predictive accuracy of 84.8%. The pulmonary artery wedge pressure was higher in group AR(+) than that in group AR(-) (7.4 +/- 3.0 vs 9.4 +/- 4.4 mmHg, p < 0.05). Conclusion: SR imaging is of potential clinical value for monitoring acute rejection in heart transplant recipients. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.