Huang Jie, Zheng Zhe, Hu Sheng-shou, Yang Yue-jin, Zhao Hong, Song Lai-feng, Song Yun-hu, Zhu Jun, Zhao Shi-hua
Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Nov;34(11):1005-8.
To evaluate the discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy, a pre-transplantation diagnosis was compared with the diagnosis made after macroscopic and microscopic examination of the explanted hearts in 40 cardiac transplant recipients who had undergone cardiac transplantation at our institute.
Pre-operation echocardiograms were obtained in all patients and coronary angiogram was obtained in 9 patients who had significant risk factors for coronary heart disease (CHD). CHD was considered present when there was a 75% reduction in cross-sectional luminal area of >or= 1 major coronary artery. Idiopathic dilated cardiomyopathy (IDC) was diagnosed when ventricular dilation and global reduction in ventricular systolic function were present in the absence of any identifiable cause. IDC patients with an alcohol consumption of > 100 g/day during the last 12 months before the onset of congestive heart failure were classified as having alcoholic cardiomyopathy. The pathological diagnosis of arrhythmogenic right ventricular cardiomyopathy was formulated in the presence of gross/or histological evidence of regional or diffuse transmural fatty or fibrofatty infiltration of the right ventricular free wall.
Before transplantation, 45.0%, 17.5%, 17.5% and 7.5% of patients were classified as IDC, CHD, alcoholic cardiomyopathy and hypertrophic cardiomyopathy. Post-transplant CHD diagnosis was made in all patients with a pre-transplant diagnosis of CHD. Post-transplant CHD diagnosis was also established in 4 patients with a pre-transplant diagnosis of IDC, in 4 patients with presumptive alcoholic cardiomyopathy, in 1 patient with hypertensive cardiomyopathy and in 1 patient with a pre-transplant diagnosis of aortic valve disease. Post-transplant arrhythmogenic right ventricular cardiomyopathy diagnosis was made in 6 patients with a pre-transplant diagnosis of IDC or KaShan disease. Post-transplant giant cell myocarditis diagnosis was made in 1 patient with a pre-transplant diagnosis of IDC.
Post-transplant CHD diagnosis is significantly higher than that of pre-transplant (42.5% vs. 17.5%, P < 0.05). Part of these patients might benefit from bypass surgery or PCI. Therefore, "in-depth" search for a heart failure cause, especially the coronary angiography examination, should be conducted in all heart transplantation candidates due to heart failure, regardless of their clinical presentation.
为评估终末期扩张型心肌病移植前后诊断的差异，将我院40例接受心脏移植的患者移植前诊断与移植心脏大体及显微镜检查后的诊断进行比较。
所有患者均进行术前超声心动图检查，9例有冠心病（CHD）显著危险因素的患者进行冠状动脉造影。当主要冠状动脉横截面积减少75%及以上时，考虑存在CHD。当存在心室扩张且心室收缩功能整体降低且无任何可识别病因时，诊断为特发性扩张型心肌病（IDC）。在充血性心力衰竭发作前最后12个月内酒精摄入量>100 g/天的IDC患者被归类为酒精性心肌病。当存在右心室游离壁区域性或弥漫性透壁脂肪或纤维脂肪浸润的大体/组织学证据时，做出致心律失常性右心室心肌病的病理诊断。
移植前，45.0%、17.5%、17.5%和7.5%的患者分别被归类为IDC、CHD、酒精性心肌病和肥厚型心肌病。所有移植前诊断为CHD的患者移植后均诊断为CHD。移植后CHD诊断还在4例移植前诊断为IDC的患者、4例疑似酒精性心肌病的患者、1例高血压性心肌病患者和1例移植前诊断为主动脉瓣疾病的患者中确立。移植后致心律失常性右心室心肌病诊断在6例移植前诊断为IDC或克山病的患者中做出。移植后巨细胞心肌炎诊断在1例移植前诊断为IDC的患者中做出。
移植后CHD诊断显著高于移植前（42.5%对1
