Department of Pediatrics, Division of Pediatric Cardiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Int J Cardiovasc Imaging. 2011 Oct;27(7):947-54. doi: 10.1007/s10554-010-9747-4. Epub 2010 Nov 10.
The purpose of the study is to determine the association of Doppler tissue imaging (DTI) and catheter-derived measures with rejection in pediatric heart transplant (PHT) recipients and to determine any correlation between DTI and catheter-derived measurements. Sixty echocardiograms were prospectively performed in 37 PHT recipients at the time of surveillance cardiac biopsy. During right-heart cardiac catheterization, sequential pressures of the right heart and pulmonary capillary wedge pressures (PCWP) were measured. DTI was performed to obtain peak systolic (S'), early (E') and late (A') diastolic velocities (cm/s) at tricuspid annulus, septum and mitral annulus. Septal S' and tricuspid annular A' were associated with rejection, but had low sensitivity and specificity. Elevated lateral mitral E/E' did not predict rejection. The mean pulmonary capillary wedge pressure (PCWP) and cardiac index were similar in those with and without rejection. The lateral mitral and septal E/E' did not correlate with PCWP. Some DTI-derived measures were altered during rejection, but were not clinically useful predictors of rejection. Catheter-derived measures were not significantly altered during rejection and did not correlate with DTI-derived measures. None of these measures can replace the current practice of performing cardiac biopsy for surveillance of rejection.
本研究旨在探讨组织多普勒成像（DTI）和导管衍生指标与儿科心脏移植（PHT）受者排斥反应的相关性，并确定 DTI 与导管衍生测量值之间的任何相关性。在监测性心脏活检时，前瞻性地对 37 例 PHT 受者进行了 60 次超声心动图检查。在右心导管检查期间，测量右心和肺毛细血管楔压（PCWP）的连续压力。通过 DTI 获得三尖瓣环、室间隔和二尖瓣环的收缩期峰值速度（S'）、早期（E'）和晚期（A'）舒张速度（cm/s）。室间隔 S'和三尖瓣环 A'与排斥反应有关，但敏感性和特异性较低。外侧二尖瓣 E/E'升高不能预测排斥反应。有或无排斥反应的患者平均肺毛细血管楔压（PCWP）和心指数相似。外侧二尖瓣和室间隔 E/E'与 PCWP 不相关。一些 DTI 衍生指标在排斥反应期间发生改变，但不能作为排斥反应的临床有用预测指标。导管衍生指标在排斥反应期间没有明显改变，也与 DTI 衍生指标不相关。这些指标都不能替代目前进行心脏活检监测排斥反应的做法。
