Pan Cuizhen, Wang Chunsheng, Pan Wenzhi, Shu Xianhong, Chen Hao
Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Acta Cardiol. 2011 Jun;66(3):365-70. doi: 10.1080/ac.66.3.2114137.
The purpose of this study was to examine left ventricular global function and left ventricular mechanical dyssynchrony (LVMD) after heart transplantation using three-dimensional echocardiography (RT-3DE) and to evaluate the value for RT-3DE in predicting cardiac allograft rejection (CAR).
A total of 95 consecutive patients undergoing orthotropic heart transplantation, of whom 20 had CAR and 75 had no CAR, were enrolled in this study. Forty healthy volunteers were included as the control group. All patients underwent RT-3DE examination. Time to minimum systolic volume (Tmsv) of each left ventricular segment was measured. The parameters of LVMD including the standard deviation (SD) of Tmsv of 16 segments (Tmsv 16-SD), 12 segments (Tmsv 12-SD), and 6 basal segments (Tmsv 6-SD) were automatically calculated.The parameters of LVMD were adjusted by cardiac cycle and presented in terms of percentage as Tmsv 16-SD%, Tmsv 12-SD%, and Tmsv 6-SD%.
The excursion average (Avg), excursion max (Max) and left ventricular ejection fraction (LVEF) were lower in patients with CAR than in those without CAR (all P < 0.05), while not different between patients without CAR and control subjects (all P > 0.05).The LVMD parameters, including Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-SD%, Tmsv 12-SD%, and Tmsv 6-SD%, were greater in patients with CAR than in those without CAR, while not different between patients without CAR and control subjects. All the RT-3DE parameters (LVEF and LVMD parameters) can predict CAR. However, Tmsv 16-SD (AUC 0.89 +/- 0.039, P < 0.001; sensitivity 85% and specificity 68%) and Tmsv 16-SD% (AUC 0.89 +/- 0.037, P < 0.001; sensitivity 95% and specificity 73%) offered the strongest power for detecting CAR.
CAR can induce LVMD. LVMD parameters obtained by 3D-RTE, especially Tmsv 16-SD and Tmsv 16-SD%, provides a good sensitivity and specificity for predicting CAR after heart transplantation.
本研究旨在使用实时三维超声心动图（RT-3DE）检查心脏移植术后左心室整体功能及左心室机械性不同步（LVMD），并评估RT-3DE在预测心脏移植排斥反应（CAR）中的价值。
本研究共纳入95例连续接受原位心脏移植的患者，其中20例发生CAR，75例未发生CAR。另外纳入40名健康志愿者作为对照组。所有患者均接受RT-3DE检查。测量左心室各节段的最小收缩容积时间（Tmsv）。自动计算LVMD参数，包括16节段Tmsv的标准差（SD）（Tmsv 16-SD）、12节段Tmsv的标准差（Tmsv 12-SD）和6个基底节段Tmsv的标准差（Tmsv 6-SD）。LVMD参数经心动周期校正后以百分比形式呈现，即Tmsv 16-SD%、Tmsv 12-SD%和Tmsv 6-SD%。
发生CAR的患者其偏移平均值（Avg）、偏移最大值（Max）和左心室射血分数（LVEF）低于未发生CAR的患者（均P<0.05），而未发生CAR的患者与对照组之间无差异（均P>0.05）。包括Tmsv 16-SD、Tmsv 12-SD、Tmsv 6-SD、Tmsv 16-SD%、Tmsv 12-SD%和Tmsv 6-SD%在内的LVMD参数，发生CAR的患者高于未发生CAR的患者，而未发生CAR的患者与对照组之间无差异。所有RT-3DE参数（LVEF和LVMD参数）均可预测CAR。然而，Tmsv 16-SD（曲线下面积[AUC]0.89±0.039，P<0.001；敏感度85%，特异度68%）和Tmsv 16-SD%（AUC 0.89±0.037，P<0.001；敏感度95%，特异度73%）在检测CAR方面具有最强的预测能力。
CAR可导致LVMD。通过三维实时超声心动图获得的LVMD参数，尤其是Tmsv 16-SD和Tmsv 16-SD%，在预测心脏移植术后CAR方面具有良好的敏感度和特异度。
