经胸对比增强超声心动图评估的冠状动脉血流速度模式及冠状动脉血流储备可预测心脏移植的长期预后。

Coronary flow velocity pattern and coronary flow reserve by contrast-enhanced transthoracic echocardiography predict long-term outcome in heart transplantation.

作者信息

Tona Francesco, Caforio Alida L P, Montisci Roberta, Gambino Antonio, Angelini Annalisa, Ruscazio Massimo, Toscano Giuseppe, Feltrin Giuseppe, Ramondo Angelo, Gerosa Gino, Iliceto Sabino

机构信息

Department of Cardiology , University of Padova, Padova, Italy.

出版信息

Circulation. 2006 Jul 4;114(1 Suppl):I49-55. doi: 10.1161/CIRCULATIONAHA.105.001321.

DOI:10.1161/CIRCULATIONAHA.105.001321

PMID:16820624

Abstract

BACKGROUND

We assessed coronary flow velocity pattern and coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) as markers of major adverse cardiac events (MACE) related to cardiac allograft vasculopathy (CAV) after heart transplantation (HT).

METHODS AND RESULTS

Deceleration time of diastolic flow velocity (DDT) and CFR were measured in the left anterior descending coronary artery (LAD) by CE-TTE in 66 consecutive HT patients (follow-up 19+/-5 months). CFR was calculated as the ratio of hyperemic to basal diastolic flow velocity. Angiographies were analyzed by a qualitative grading system; CAV was defined as changes grade II or higher. MACE were cardiac death, stent implantation, and heart failure. Patients with MACE had higher CAV incidence (P=0.004) and grade (P=0.008), shorter DDT (P=0.006), and lower CFR (P=0.008). A receiver-operating characteristic-derived DDT cutpoint < or = 840 ms (area under the curve 0.793; P=0.01) was 75% specific and 86% sensitive for predicting MACE, with positive predictive value (PPV) and negative predictive value (NPV) of 33% and 97%, respectively (P=0.002). A CFR cutpoint of < or =2.6 (area under the curve 0.746; P=0.01) was 62% specific and 91% sensitive for predicting MACE (PPV =32%, NPV =97%) (P=0.001). Patients with CFR < or = 2.6 and patients with DDT < or = 840 ms had a lower survival free from MACE (P=0.006 and P=0.009, respectively). By Cox regression, only a lower CFR predicted the risk of MACE (relative risk 3.1; 95% CI, 1.26 to 7.9; P=0.01).

CONCLUSIONS

In HT patients, shorter DDT and lower CFR by CE-TTE are reliable markers for CAV-related MACE. CFR is the main independent predictor of MACE.

摘要

背景

我们通过对比增强经胸超声心动图（CE-TTE）评估冠状动脉血流速度模式和冠状动脉血流储备（CFR），将其作为心脏移植（HT）后与心脏移植血管病变（CAV）相关的主要不良心脏事件（MACE）的标志物。

方法与结果

通过CE-TTE在66例连续的HT患者中测量左前降支冠状动脉（LAD）的舒张期血流速度减速时间（DDT）和CFR（随访时间19±5个月）。CFR计算为充血期与基础舒张期血流速度之比。血管造影通过定性分级系统进行分析；CAV定义为II级或更高等级的变化。MACE包括心源性死亡、支架植入和心力衰竭。发生MACE的患者CAV发生率更高（P = 0.004）且等级更高（P = 0.008），DDT更短（P = 0.006），CFR更低（P = 0.008）。基于受试者工作特征曲线得出的DDT切点≤840毫秒（曲线下面积0.793；P = 0.01）对预测MACE的特异性为75%，敏感性为86%，阳性预测值（PPV）和阴性预测值（NPV）分别为33%和97%（P = 0.002）。CFR切点≤2.6（曲线下面积0.746；P = 0.01）对预测MACE的特异性为62%，敏感性为91%（PPV = 32%，NPV = 97%）（P = 0.001）。CFR≤2.6的患者和DDT≤840毫秒的患者无MACE的生存率较低（分别为P = 0.006和P = 0.009）。通过Cox回归分析，只有较低的CFR可预测MACE风险（相对风险3.1；95%可信区间，1.26至7.9；P = 0.01）。