EFFECT OF ACUTE HUMAN CARDIAC ALLOGRAFT-REJECTION ON LEFT-VENTRICULAR SYSTOLIC TORSION AND DIASTOLIC RECOIL MEASURED BY INTRAMYOCARDIAL MARKERS
EFFECT OF ACUTE HUMAN CARDIAC ALLOGRAFT-REJECTION ON LEFT-VENTRICULAR SYSTOLIC TORSION AND DIASTOLIC RECOIL MEASURED BY INTRAMYOCARDIAL MARKERS
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DOI：
10.1161/01.cir.76.5.998
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发表时间：
1987-11-01
期刊：
影响因子：
37.8
通讯作者：
MILLER, DC
中科院分区：
文献类型：
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作者：
HANSEN, DE;DAUGHTERS, GT;MILLER, DC
应用计算机辅助分析双平面摄影图像，对12例接受心脏移植手术植入心肌标记物的受者的左室收缩扭转和舒张期反冲进行了量化。测量在术后6至16周之间进行，并与心脏活检所确定的有无排斥反应有关。扭转变形，定义为绕左室心尖区长轴相对于心尖部的扭转，通过内部参照系以收缩扭转的速率和幅度以及舒张期的回弹率来表征。比较14例排斥反应恢复前、恢复期间和恢复后的测量结果，可以评估急性可逆性心肌病对左心室扭转和反冲的影响。与预排出值相比，最大变形节段的扭转变形幅度(θmax)从21.1±-下降了25%。15.2至16.0。+-。在伴有心肌细胞坏死的急性排斥反应期间5.7度(p<；0.005)；这与收缩峰值扭转率(+d.theta/dtmax)显著降低(p<；0.05)有关，而舒张期峰值反弹率(-d.theta/dtmax)不变。这表明，心肌弹性成分的硬度可能增加了，当这些成分拉伸较少时，保持了舒张期回弹率。随着排斥反应的成功治疗，扭转变形特征恢复正常。心率、平均动脉压、左心室舒张末期容量、每搏量、射血分数和最大左心室充盈率在发生排斥反应时没有变化，而左心室收缩末期容量在急性排斥反应期间增加(p<；0.05)，并随着排斥反应的缓解而恢复正常。这些数据表明，左心室扭转变形的幅度和速率对亚临床左心功能不全的发作很敏感，这种心肌内标记物技术可能为了解左室心肌的弹性特性及其对左心室力学的影响提供新的见解。
Left ventricular systolic torsion and diastolic recoil were quantified in 12 human cardiac transplant recipients with surgically implanted intramyocardial markers with the use of computer-aided analysis of biplane cineradiographic images. Measurements were performed between 6 and 16 weeks after surgery and related to the presence or absence of rejection as determined by cardiac biopsy. Torsional deformation, defined as twisting about the left ventricular long axis of the apical region with respect to the base, was characterized in terms of the rate and amplitude of systolic torsion and the rate of diastolic recoil by means of an internal reference system. Comparison of measurements before, during, and after recovery from 14 rejection episodes allowed assessment of the effects of acute reversible cardiomyopathy on left ventricular torsion and recoil. Compared with prerejection values, the amplitude of torsional deformation in the maximally deforming segment (.theta.max) decreased by 25% from 21.1 .+-. 15.2 to 16.0 .+-. 5.7 degrees (p < .005) during acute rejection with myocyte necrosis; this was associated with significant (p < .05) decreases in the peak systolic torsion rate (+ d.theta./dtmax), whereas the peak diastolic recoil rate (-d.theta./dtmax) was unchanged. This suggests that the stiffness of elastic components of the myocardium may have increased, maintaining the rate of diastolic recoil when these elements are stretched less. With successful treatment of rejection episodes, the torsional deformation characteristics normalized. Heart rate, mean arterial pressure, left ventricular end-diastolic volume, stroke volume, ejection fraction, and peak left ventricular filling rate were unchanged with rejection episodes, whereas left ventricular end-systolic volume increased (p < .05) during acute rejection and returned to normal with resolution of the rejection process. These data suggest that left ventricular torsional deformation amplitude and rate are sensitive to episodes of subclinical left ventricular dysfunction and that such intramyocardial marker techniques may provide new insights regarding the elastic properties of the ventricular myocardium and their impact on left ventricular mechanics.