Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
JACC Cardiovasc Imaging. 2010 Oct;3(10):989-1000. doi: 10.1016/j.jcmg.2010.07.009.
The aim of this study was to explore the temporal evolution of left ventricular (LV) mechanics in relation to clinical variables and genetic expression profiles implicated in cardiac allograft function.
Considerable uncertainty exists regarding the range and determinants of variability in LV systolic performance in transplanted hearts (TXH).
Fifty-one patients (mean age 53 ± 12 years; 37 men) underwent serial assessment of echocardiograms, cardiac catheterization, gene expression profiles, and endomyocardial biopsy data within 2 weeks and at 3, 6, 12, and 24 months after transplantation. Two-dimensional speckle-tracking data were compared between patients with TXH and 37 controls (including 12 post-coronary artery bypass patients). Post-transplantation mortality and hospitalizations were recorded with a median follow-up period of 944 days.
Global longitudinal strain (LS) and radial strain remained attenuated in patients with TXH at all time points (p < 0.001 and p = 0.005), independent of clinical rejection episodes. Failure to improve global LS at 3 months (≥ 1 SD) was associated with higher incidence of death and cardiac events (hazard ratio: 5.92; 95% confidence interval: 1.96 to 17.91; p = 0.049). Multivariate analysis revealed gene expression score as the only independent predictor of global LS (R(2) = 0.53, p = 0.005), with SEMA7A gene expression having the highest correlation with global LS (r = -0.84, p < 0.001).
Speckle tracking-derived LV strains are helpful in estimating the burden of LV dysfunction in patients with TXH that evolves independent of biopsy-detected cellular rejection. Failure to improve global LS at 3 months after transplantation is associated with a higher incidence of death and cardiac events. Serial changes in LV mechanics correlate with peripheral blood gene expression profiles and may affect the clinical assessment of long-term prognosis in patients with TXH.
本研究旨在探讨左心室（LV）力学与临床变量和心脏移植功能相关的基因表达谱的时间演变关系。
在移植心脏（TXH）中，LV 收缩功能的可变性范围和决定因素存在很大的不确定性。
51 例患者（平均年龄 53 ± 12 岁；37 名男性）在移植后 2 周内以及 3、6、12 和 24 个月时进行了超声心动图、心导管检查、基因表达谱和心肌活检数据的系列评估。将 TXH 患者与 37 名对照者（包括 12 名冠状动脉旁路移植术后患者）的二维斑点追踪数据进行了比较。记录了移植后死亡率和住院率，中位随访时间为 944 天。
在所有时间点，TXH 患者的整体纵向应变（LS）和径向应变均减弱（p < 0.001 和 p = 0.005），与临床排斥发作无关。3 个月时（≥ 1 SD）整体 LS 无改善与更高的死亡率和心脏事件发生率相关（风险比：5.92；95%置信区间：1.96 至 17.91；p = 0.049）。多变量分析显示基因表达评分是整体 LS 的唯一独立预测因子（R2 = 0.53，p = 0.005），SEMA7A 基因表达与整体 LS 相关性最强（r = -0.84，p < 0.001）。
斑点追踪衍生的 LV 应变有助于估计 TXH 患者 LV 功能障碍的负担，这种负担与活检检测到的细胞排斥无关。移植后 3 个月时整体 LS 无改善与更高的死亡率和心脏事件发生率相关。LV 力学的连续变化与外周血基因表达谱相关，可能影响 TXH 患者的长期预后临床评估。
