Ruiz Ortiz Martín, Peña María Luisa, Mesa Dolores, Delgado Mónica, Romo Elías, Santisteban Marta, Puentes Miguel, López Granados Amador, Castillo Juan Carlos, Arizón José María, de Lezo José Suárez
Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain.
Echocardiography. 2015 Feb;32(2):229-37. doi: 10.1111/echo.12623. Epub 2014 May 10.
Our objective was to evaluate the impact of asymptomatic acute cellular rejection (ACR) in left ventricular myocardial strain in heart transplant (HT) recipients by means of two-dimensional speckle tracking echocardiography (2DSTE).
From September 1, 2009 to December 15, 2010 a conventional echocardiography and 2DSTE exam was performed on all consecutive HT recipients in their first year posttransplantation within 3 hours of the surveillance endomyocardial biopsies, as well as on 14 healthy controls. The association of strain echocardiographic variables with different grades of ACR was investigated.
Of the 78 studies performed 4 ± 3 months after HT in 20 patients, 32 studies were coincident with grade 0R rejection, 41 with grade 1R, and 5 with grade 2R. Significantly lower values of average radial strain were found with higher grades of ACR (29.1 ± 7.7%, 23.2 ± 8.5%, and 14.3 ± 8.8% for grades 0R, 1R, and 2R of ACR, P = 0.001). Average deformation was similar for controls versus transplanted patients, in the absence of acute rejection: radial 29.1 ± 10.0% versus 29.1 ± 7.7%, P = 0.98; circumferential -19.3 ± 3.2% versus -20.2 ± 5.9%, P = 0.62; and longitudinal -20.7 ± 4.1% versus -18.5 ± 5.4%, P = 0.19. An average radial strain <25% presented 100% sensitivity, 48% specificity, 6% positive predictive value, and 100% negative predictive value for the presence of 2R rejection (area under the curve 0.80, IC 95% 0.60-0.99, P = 0.048).
In this study, HT recipients showed significantly lower values of average radial left ventricle strain, evaluated by means of 2DSTE, with the presence of ACR.
我们的目的是通过二维斑点追踪超声心动图（2DSTE）评估无症状急性细胞排斥反应（ACR）对心脏移植（HT）受者左心室心肌应变的影响。
从2009年9月1日至2010年12月15日，对所有连续的HT受者在移植后第一年监测心内膜心肌活检后3小时内进行常规超声心动图和2DSTE检查，并对14名健康对照者进行检查。研究了应变超声心动图变量与不同等级ACR之间的关联。
在20例患者HT后4±3个月进行的78项研究中，32项研究与0R级排斥反应相符，41项与1R级相符，5项与2R级相符。ACR等级越高，平均径向应变值越低（ACR的0R、1R和2R级分别为29.1±7.7%、23.2±8.5%和14.3±8.8%，P = 0.001）。在没有急性排斥反应的情况下，对照组与移植患者的平均变形相似：径向分别为29.1±10.0%和29.1±7.7%，P = 0.98；圆周分别为-19.3±3.2%和-20.2±5.9%，P = 0.62；纵向分别为-20.7±4.1%和-18.5±5.4%，P = 0.19。平均径向应变<25%对2R级排斥反应的存在具有100%的敏感性、48%的特异性、6%的阳性预测值和100%的阴性预测值（曲线下面积0.80，95%置信区间0.60-0.99，P = 0.048）。
在本研究中，通过2DSTE评估，HT受者在存在ACR时左心室平均径向应变值显著降低。
