Habib G, Benichou M, Salaun-Penquer P, Pietri P, Bonnet J L, Scheiner C, Metras D, Bory M, Djiane P, Serradimigni A
Service de cardiologie, CHU Timone, Marseille.
Arch Mal Coeur Vaiss. 1989 Sep;82(9):1535-41.
In a prospective study of 23 patients who had undergone orthotopic heart transplantation we tried to assess the value of doppler-echocardiography in the detection of acute graft rejection. For this purpose, 220 echocardiographic records were compared with the results of endomyocardial biopsies performed at an interval of less than 12 hours. The parameters investigated by TM and two-dimensional echocardiography were: morphological parameters (including septal echodensity), left ventricular mass and systolic function parameters. Diastolic parameters (isovolumetric relaxation time [IVR], transmitral gradient half-decrease time [T 1/2] and proto-end-diastolic mitral velocity ratio [E/A] were measured by TM echocardiography and pulsed doppler velocimetry. The best doppler-echocardiographic criteria for graft rejection were a more than 15 ms reduction of IVR, a more than 15 p. 100 increase of myocardial mass, and a more than 30 p. 100 increase of teh E/A ratio, the corresponding sensitivities for histological rejection being 82, 76 and 74 p. 100 respectively. In contrast, T 1/2 and systolic function studies seemed to be disappointing. Finally, the increase of septal echodensity enabled rejection to be diagnosed with an excellent (92 p. 100) specificity but an insufficient sensitivity. Thus, none of the parameters measured were sensitive enough, taken separetely, to replace endomyocardial biopsy. However, the combined use of the most sensitive of them should make it possible to reduce the frequency of systematic biopsies.
在一项对23例接受原位心脏移植患者的前瞻性研究中，我们试图评估多普勒超声心动图在检测急性移植物排斥反应中的价值。为此，将220份超声心动图记录与间隔时间少于12小时进行的心肌内膜活检结果进行了比较。经胸超声心动图（TM）和二维超声心动图研究的参数包括：形态学参数（包括室间隔回声密度）、左心室质量和收缩功能参数。舒张功能参数（等容舒张时间[IVR]、二尖瓣跨瓣压差减半时间[T 1/2]和舒张末期二尖瓣血流速度比值[E/A]）通过TM超声心动图和脉冲多普勒测速法进行测量。移植物排斥反应的最佳多普勒超声心动图标准为IVR减少超过15毫秒、心肌质量增加超过15%、E/A比值增加超过30%，组织学排斥反应的相应敏感度分别为82%、76%和74%。相比之下，T 1/2和收缩功能研究似乎令人失望。最后，室间隔回声密度增加能够以极高的特异性（92%）诊断排斥反应，但敏感度不足。因此，单独测量的任何参数都不够敏感，无法取代心肌内膜活检。然而，联合使用其中最敏感的参数应能够减少系统性活检的频率。
