Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2011 Jul;97(1):8-16. doi: 10.1590/s0066-782x2011005000060. Epub 2011 May 13.
Endomyocardial biopsy (EMB) is the gold standard method for the diagnosis of cellular rejection (CR) after heart transplantation (HT).
To test the hypothesis that tissue Doppler imaging (TDI) could detect CR > 3A and add diagnostic information compared to conventional Doppler.
Fifty-four HT patients underwent 129 EMB and a TDI echocardiographic study within 24 hours. We compared HT patients with CR > 3A versus HT patients with CR < 3A, with a normal matched control group (13 patients). We measured TDI systolic (S), early diastolic (e'), late diastolic (a') velocities and e'/a' ratio in the left ventricular annulus, basal and medium (mid) segments of the septal (SEP), lateral (LAT), inferior (INF), anterior (ANT) walls; and in the right ventricular annulus.
HT patients showed CR > 3A in 39/129 (30.2%) EMB. The best isolated predictor for CR diagnosis was a'LAT, with a sensitivity of 76.3%, specificity of 73.8% (p = 0.001). In the multivariate analysis, a'LAT (p = 0.001), a'SEP (p = 0.002), e'/a' LAT ratio (p = 0.006), e'Mitral/ e'LAT ratio (p = 0.014), SINF (p = 0.009) predicted CR > 3A. We obtained a score with a sensitivity of 88.2%, accuracy of 79.6% and negative predictive value of 92.9% to diagnose CR > 3A. Conventional Doppler (mitral and pulmonary venous flow) was not relevant to predict CR > 3A.
TDI added diagnostic information to predict CR > 3A compared to conventional Doppler. A TDI-based model could become a potential method to detect CR > 3A after heart transplantation.
心肌内膜活检（EMB）是心脏移植（HT）后细胞排斥（CR）诊断的金标准方法。
检验组织多普勒成像（TDI）能够检测到 >3A 级 CR 并与传统多普勒相比提供更多诊断信息的假设。
54 例 HT 患者在 24 小时内接受了 129 次 EMB 和 TDI 超声心动图研究。我们比较了 CR > 3A 的 HT 患者与 CR < 3A 的 HT 患者，以及 13 名正常匹配的对照组患者。我们测量了左心室瓣环、间隔（SEP）的基底和中段（mid）、侧壁（LAT）、下壁（INF）、前壁（ANT）和右心室瓣环的 TDI 收缩期（S）、早期舒张期（e'）、晚期舒张期（a'）速度和 e'/a'比值。
在 129 次 EMB 中有 39 次（30.2%）HT 患者表现为 >3A 级 CR。诊断 CR 的最佳孤立预测因子是 a'LAT，其敏感性为 76.3%，特异性为 73.8%（p = 0.001）。在多变量分析中，a'LAT（p = 0.001）、a'SEP（p = 0.002）、e'/a'LAT 比值（p = 0.006）、e'Mitral/e'LAT 比值（p = 0.014）、SINF（p = 0.009）均预测了 >3A 级 CR。我们获得了一种评分，其诊断 >3A 级 CR 的敏感性为 88.2%，准确性为 79.6%，阴性预测值为 92.9%。传统多普勒（二尖瓣和肺静脉血流）与预测 >3A 级 CR 无关。
与传统多普勒相比，TDI 提供了更多诊断信息来预测 >3A 级 CR。基于 TDI 的模型可能成为检测心脏移植后 >3A 级 CR 的一种潜在方法。
