Department of Cardiology, University of Padova, Italy.
Am J Transplant. 2010 Jul;10(7):1668-76. doi: 10.1111/j.1600-6143.2010.03160.x.
Cardiac allograft vasculopathy (CAV) is the leading cause of morbidity and mortality in heart transplantation (HT). We sought to investigate the role of coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in CAV diagnosis. CAV was defined as maximal intimal thickness (MIT) assessed by intravascular ultrasound (IVUS) > or =0.5 mm. CFR was assessed in the left anterior descending coronary artery in 22 HT recipients at 6 +/- 4 years post-HT. CAV was diagnosed in 10 patients (group A), 12 had normal coronaries (group B). The mean MIT was 0.7 +/- 0.1 mm (range 0.03-1.8). MIT was higher in group A (1.16 +/- 0.3 mm vs. 0.34 +/- 0.07 mm, p < 0.0001). CFR was 3.1 +/- 0.8 in all patients and lower in group A (2.5 +/- 0.6 vs. 3.7 +/- 0.3, p < 0.0001). CFR was inversely related with MIT (r =-0.774, p < 0.0001). A cut point of < or =2.9, identified as optimal by receiver operating characteristics analysis was 100% specific and 80% sensitive (PPV = 100%, NPV = 89%, Accuracy = 91%). CFR assessment by CE-TTE is a novel noninvasive diagnostic tool in the detection of CAV defined as MIT > or =0.5 mm. CFR by CE-TTE may reduce the need for routine IVUS in HT.
心脏移植术后的冠状动脉血管病（CAV）是心脏移植（HT）术后发病率和死亡率的主要原因。我们试图通过对比增强经胸超声心动图（CE-TTE）研究冠状动脉血流储备（CFR）在 CAV 诊断中的作用。CAV 定义为血管内超声（IVUS）评估的最大内膜厚度（MIT）≥0.5mm。在 22 例 HT 受者中，在 HT 后 6±4 年时评估左前降支冠状动脉的 CFR。10 例患者诊断为 CAV（A 组），12 例冠状动脉正常（B 组）。平均 MIT 为 0.7±0.1mm（范围 0.03-1.8）。A 组 MIT 更高（1.16±0.3mm 比 0.34±0.07mm，p＜0.0001）。所有患者的 CFR 均为 3.1±0.8，A 组较低（2.5±0.6 比 3.7±0.3，p＜0.0001）。CFR 与 MIT 呈负相关（r=-0.774，p＜0.0001）。通过 ROC 分析确定的＜或=2.9 为最佳截断值，特异性为 100%，敏感性为 80%（PPV=100%，NPV=89%，准确性=91%）。CE-TTE 评估的 CFR 是一种新的非侵入性诊断工具，用于检测 MIT≥0.5mm 的 CAV。CE-TTE 的 CFR 可能减少 HT 中常规 IVUS 的需求。
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