Tallaj José A, Kirklin James K, Brown Robert N, Rayburn Barry K, Bourge Robert C, Benza Raymond L, Pinderski Laura, Pamboukian Salpy, McGiffin David C, Naftel David C
Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA.
J Am Coll Cardiol. 2007 Sep 11;50(11):1064-9. doi: 10.1016/j.jacc.2007.06.007. Epub 2007 Aug 24.
The purpose of this study was to evaluate the incidence and prognostic implication of diastolic dysfunction (DD) occurring in the first year after transplant.
Diastolic dysfunction is a recognized complication in heart transplant recipients, but its true incidence and natural history has been poorly characterized. We studied the prognostic implication of DD, as defined by elevated filling pressures with normal systolic function, occurring in the first year after transplant.
Between June 1992 and June 2002, all patients who underwent heart transplantation at a single institution were included in the study (231 at 6 weeks and 250 at 6 months and 1 year). Diastolic dysfunction was defined as right atrial pressure (RAP) >/=15 mm Hg (right ventricular [RV] DD) or pulmonary capillary wedge pressure >/=18 mm Hg (left ventricular [LV] DD) with normal systolic function by echocardiogram and without severe mitral or tricuspid insufficiency. In addition, RV DD was defined by a RAP/stroke volume (SV) ratio.
The incidence of DD was 22%, 8%, and 12% at 6 weeks, 6 months, and 1 year, respectively. The incidence of LV DD was more frequent than that of RV DD at any time point (p < 0.0001). By multivariable analysis RV DD, as manifested by an elevated RAP/SV, but not LV DD was a strong predictor of cardiac mortality at all time points.
Diastolic dysfunction is common early after transplant, and its incidence decreases during the first year. Right ventricular DD, as measured by an elevated RAP/SV ratio, but not LV DD is a strong predictor of cardiac mortality. Further studies are needed to evaluate the functional status of patients with RV or LV DD and whether aggressive medical therapy for early DD could alter outcome.
本研究旨在评估心脏移植后第一年发生舒张功能障碍（DD）的发生率及其预后意义。
舒张功能障碍是心脏移植受者中公认的并发症，但其真实发生率和自然病程尚未得到充分描述。我们研究了移植后第一年发生的以收缩功能正常但充盈压升高为定义的舒张功能障碍的预后意义。
1992年6月至2002年6月期间，在单一机构接受心脏移植的所有患者纳入本研究（6周时231例，6个月和1年时250例）。舒张功能障碍定义为右心房压力（RAP）≥15 mmHg（右心室舒张功能障碍[RV DD]）或肺毛细血管楔压≥18 mmHg（左心室舒张功能障碍[LV DD]），超声心动图显示收缩功能正常且无严重二尖瓣或三尖瓣关闭不全。此外，RV DD通过RAP/每搏量（SV）比值定义。
DD的发生率在6周、6个月和1年时分别为22%、8%和12%。在任何时间点，LV DD的发生率均高于RV DD（p<0.0001）。多变量分析显示，以RAP/SV升高为表现的RV DD而非LV DD是所有时间点心脏死亡的强有力预测因素。
舒张功能障碍在移植后早期很常见，且其发生率在第一年下降。通过升高的RAP/SV比值测量的右心室舒张功能障碍而非左心室舒张功能障碍是心脏死亡的强有力预测因素。需要进一步研究来评估RV或LV DD患者的功能状态，以及早期舒张功能障碍的积极药物治疗是否能改变预后。
