Donation after circulatory death hearts recipients compared to donation after brain death heart recipients have comparable systolic left ventricular function and better myocardial strain at 1 year
Donation after circulatory death hearts recipients compared to donation after brain death heart recipients have comparable systolic left ventricular function and better myocardial strain at 1 year
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与脑死亡心脏接受者捐赠相比，循环死亡心脏接受者捐赠一年后具有相似的左心室收缩功能和更好的心肌应变
DOI：
10.1093/ehjci/ehaa946.1108
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发表时间：
2020
影响因子：
39.3
通讯作者：
S. Large
中科院分区：
文献类型：
--
作者：
A. Ciarka;A. Page;S. Messer;E. Pavlushkov;S. Tsui;J. Parameshwar;L. Williams;B. Aggraval;S. Large
我院自2015年2月开始实施循环死亡后捐献心脏移植（DCD）。尽管结果令人鼓舞，但在较长时间的随访中，热缺血和再灌注损伤对心肌状态的影响可能会引起一些担忧。因此，我们的目的是分析DCD和脑死亡（DBD）心脏受者捐赠后1年的左心室收缩性能，通过超声心动图和心肌变形成像进行评估。
我们确定了2015年2月至2018年8月期间移植的46名连续DCD心脏受体，并将其与46名DBD心脏受体进行了匹配。DCD组和DBD组分别有6例和7例患者在移植后第一年死亡。在其余患者中，我们比较了经典超声心动图测量以及1年随访时的总体纵向应变（GLS）和总体周向应变（GCS）。
在一年随访时，DCD和DBD患者在左心室（LV）结构和收缩功能的经典超声心动图参数方面没有差异。DCD和DBD患者的LVEDV相似（分别为101±24 vs. 95±32 ml，p=0.4），LVESV相似（分别为42±13 vs. 42±16 ml，p=0.9），LV射血分数相似（分别为58±6 vs. 56± 8%，p=0.22），LV质量相似（分别为156±39 vs. 163±38 gr，p=0.2）。相比之下，心肌变形参数，如GLS和GCS，在DCD中优于DBD（分别为16.1 vs. − 14.5%，p<0.01;和−25.2 vs. 22.3%，p<0.05）。DCD组与DBD组左室舒张功能参数（E波速度、A波速度和二尖瓣血流减速时间）相似，但DCD组E/E prime比值低于DBD组（7.7±8.7，p<0.05）。DCD组右心室面积变化分数高于DBD组（46±7 vs. 40± 7%，p<0.01），而右心房容积指数低于DBD组（25±8 vs. 29±9 ml/m2，p<0.01）。两组的其他RV功能参数（三尖瓣环收缩期偏移，TAPSE）相似。
根据经典超声心动图参数评估，DCD和DBD心脏受体在1年随访时具有相似的收缩期LV功能。DCD心脏受体具有更好的心肌变形参数，如斑点追踪评估，更好的右心室收缩功能和更低的左心室充盈压。
资金来源类型：无
Cardiac transplantation from donation after circulatory death (DCD) has been implemented at our hospital since February 2015. Despite encouraging results some concerns may be raised about the impact of the warm ischemia and reperfusion injury on the myocardium status at longer follow-up. Therefore, we aimed to analyse systolic performance of the left ventricle at 1 year follow in DCD and donation after brain death (DBD) cardiac recipients, as assessed by echocardiography with myocardial deformation imaging.
We identified 46 consecutive DCD cardiac recipients who were transplanted from February 2015 to August 2018 and we matched them with 46 DBD cardiac recipients. Six and 7 patients from DCD and DBD group, respectively, died in the first-year post transplant. In the remaining patients we have compared the classical echocardiographic measurements as well as global longitudinal strain (GLS) and global circumferential strain (GCS) at 1-year follow-up.
DCD and DBD patients did not present with differences in terms of classical echocardiographic parameters of left ventricular (LV) structure and systolic function at one-year follow-up. LVEDV was similar in DCD and DBD patients (101±24 vs. 95±32 ml, p=0.4 respectively), as well as LVESV (42±13 vs. 42±16 ml, p=0.9, respectively), LV ejection fraction (58±6 vs. 56±8%, p=0.22) and LV mass (156±39 vs. 163±38 gr, p=0.2, respectively). In contrast, myocardial deformation parameters, such as GLS and GCS, were better in DCD than in DBD (16.1 vs. −14.5%, p<0.01; and −25.2 vs. 22.3%, p<0.05, respectively). The diastolic LV function parameters were similar in DCD and DBD group, as evidenced by E wave velocity, A wave velocity and deceleration time of mitral inflow, however E over E prime was lower in DCD than in DBD recipients (7.7±8.7, p<0.05). Fractional area change of the right ventricle was higher in DCD in comparison with DBD (46±7 vs. 40±7%, p<0.01) while right atrial volume index was lower in DCD than in DBD (25±8 vs. 29±9 ml/m2, p<0.01). Other parameters of RV function (systolic excursion of the tricuspid annulus, TAPSE) were similar in both groups.
DCD and DBD heart recipients present with similar systolic LV function at 1-year follow, as assessed by classical echocardiographic parameters. DCD cardiac recipients have better myocardial deformation parameters as assessed by the speckle tracking, better systolic right ventricular function and lower filling pressures of the left ventricle.
Type of funding source: None