Optical Coherence Tomography and Highly Sensitivity Troponin T for Evaluating Cardiac Allograft Vasculopathy
Optical Coherence Tomography and Highly Sensitivity Troponin T for Evaluating Cardiac Allograft Vasculopathy
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DOI：
10.1016/j.amjcard.2012.04.047
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发表时间：
2012-09-01
影响因子：
2.8
通讯作者：
Pascual-Figal, Domingo A.
中科院分区：
文献类型：
--
作者：
Garrido, Iris P.;Garcia-Lara, Juan;Pascual-Figal, Domingo A.
同种异体心脏移植物血管病变（CAV）是心脏移植术后移植物长期存活的主要障碍。血管内超声（IVUS）在诊断方面比冠状动脉造影更敏感，但对特定斑块成分或斑块组成的识别有限。此外，显然需要其他非侵入性工具来诊断CAV。本研究的目的是评估两种评估CAV的新技术的效用：光学相干断层扫描（OCT）和新的高灵敏度肌钙蛋白T （hsTnT）检测。对21例心脏移植患者行冠状动脉造影（IVUS）和OCT。采用两种技术测量最严重部位的最大内膜厚度（MIT）和管腔面积。在心导管插入术之前，立即采集血液样本并测量hsTnT水平。OCT对CAV的评估与IVUS测量结果具有良好的相关性，MIT的平均差异为0.0033(95%可信区间为-0.049至0.043)，利用了较低的观察者间变异性（OCT的r = 0.94，而IVUS的r = 0.78）和更好的斑块表征。当在多元线性回归模型中评估MIT的独立预测因子时，移植后时间（beta = 0.488, p = 0.004）和hsTnT （beta = 0.392, p = 0.011）是MIT的唯一独立预测因子（R-2 = 0.591）。总之，本研究首次在CAV具有挑战性的情况下评估OCT和hsTnT这两种新技术。研究结果表明，OCT比IVUS提供更低的观察者间变异性和更好的斑块表征。此外，hsTnT可能成为排除CAV的有用工具。(c) 2012 Elsevier Inc.版权所有。（中国医学杂志2012；11:655-661）
Cardiac allograft vasculopathy (CAV) is a major impediment to long-term graft survival after heart transplantation. Intravascular ultrasound (IVUS) is more sensitive than coronary angiography for diagnosis, but the identification of specific plaque components or plaque composition is limited. In addition, there is an evident need for other noninvasive tools for diagnosing CAV. The aim of this study was to assess the utility of 2 new techniques for evaluating CAV: optical coherence tomography (OCT), and new high-sensitivity troponin T (hsTnT) assays. In 21 heart transplantation patients, coronary arteriography with IVUS and OCT were performed. Maximal intimal thickness (MIT) and luminal area at the most severe site were measured using the 2 techniques. Immediately before cardiac catheterization, blood samples were obtained and hsTnT levels measured. The evaluation of CAV by OCT showed a good correlation with IVUS measurements, with a mean difference in MIT of 0.0033 (95% confidence interval -0.049 to 0.043), taking advantage of lower interobserver variability (r = 0.94 for OCT vs r = 0.78 for IVUS) and better plaque characterization. When independent predictors of MIT were assessed in a multiple linear regression model, time after transplantation (beta = 0.488, p = 0.004) and hsTnT (beta = 0.392, p = 0.011) were the only independent predictors of MIT (R-2 = 0.591). In conclusion, this study is the first to evaluate 2 new techniques, OCT and hsTnT, in the challenging setting of CAV. The findings suggest that OCT provides lower interobserver variability and better plaque characterization than IVUS. Also, hsTnT could become a useful tool for ruling out CAV. (c) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:655-661)