Two-dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection
Two-dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection
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DOI：
10.1111/echo.14481
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发表时间：
2019-10-01
影响因子：
1.5
通讯作者：
Lemler, Matthew
中科院分区：
文献类型：
--
作者：
Engelhardt, Kevin;Das, Bibhuti;Lemler, Matthew
背景急性排斥是小儿心脏移植（HT）种群发病率和死亡率的重要原因。可靠的无创方法诊断临床排斥反应可以大大减少这些负面结果。客观评估左心室（LV）全球纵向菌株（GLS）和全球圆周菌株（GCS）作为早期的急性小儿HT排斥反应的早期无创指标。方法一项18个月的前瞻性队列研究涉及61名患者，评估了从入学率（基线）到下一个计划的临床遭遇（随访）或排斥的绝对变化。急性排斥反应定义为对年级> = 2R的活检或移植团队增强免疫抑制作用的治疗，对菌株分析视而不见。 HT三个月后，有两个患者队列，没有入学时没有被排斥的证据。该研究队列经历了拒绝。控制队列仍未在随访中拒绝。两向方差分析（ANOVA）模型评估了队列组和时间的GLS和GC的变化。采用排除标准的结果，51名患者参加了对照组，研究队列中有10例。研究队列的平均GL从基线到排斥分别下降了33％（p <.001），平均GC下降了16.6％（p = .021）。从基线到随访中没有显着变化。 16.1％的阈值绝对GLS值鉴定出具有100％敏感性和98％特异性的急性排斥（似然比，[LR] 51）。结论非侵入性全球纵向菌株在鉴定小儿HT受体中急性临床排斥反应方面是敏感和特异的。
Background Acute rejection is an important cause of morbidity and mortality in the pediatric heart transplant (HT) population. A reliable noninvasive method for diagnosis of clinical rejection could substantially reduce these negative outcomes. Objective Evaluate left ventricular (LV) global longitudinal strain (GLS), and global circumferential strain (GCS) as early noninvasive indicators of acute pediatric HT rejection. Methods An 18-month prospective cohort study involving 61 patients evaluated absolute change in peak global systolic strain (GLS and GCS) from enrollment (baseline) to next planned clinical encounter (follow-up) or rejection. Acute rejection defined as a biopsy of grade >= 2R or treatment with enhanced immunosuppression by the transplant team, blinded to strain analysis. Two patient cohorts three months post HT without evidence of rejection at enrollment were identified. The study cohort experienced rejection. The control cohort remained free from rejection on follow-up. Two-way analysis of variance (ANOVA) models evaluated change in GLS and GCS by cohort group and time. Results Applying exclusion criteria, 51 patients enrolled in the control cohort and 10 in the study cohort. The study cohort's mean GLS declined 33% from baseline to rejection (P < .001) and mean GCS declined 16.6% (P = .021). No significant change from baseline to follow-up was seen in the control cohort. A threshold absolute GLS value of 16.1% identified acute rejection with 100% sensitivity and 98% specificity (Likelihood Ratio, [LR] 51). Conclusion Noninvasive global longitudinal strain was sensitive and specific in the identification of acute clinical rejection in pediatric HT recipients.