Clemmensen Tor Skibsted, Løgstrup Brian Bridal, Eiskjær Hans, Poulsen Steen Hvitfeldt
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
J Am Soc Echocardiogr. 2015 Mar;28(3):330-9. doi: 10.1016/j.echo.2014.10.015. Epub 2014 Dec 9.
Diagnosing and monitoring acute cellular rejection (ACR) is a major objective in the surveillance of heart-transplanted patients. The aim of this study was to evaluate the value of global longitudinal strain (GLS), measured by two-dimensional speckle-tracking echocardiography, as a noninvasive tool for graft function monitoring in relation to ACR.
The study population consisted of all heart-transplanted patients who underwent biopsy and corresponding echocardiography at one institution from 2011 to 2013 (n = 64). ACR was classified according to the International Society of Heart and Lung Transplantation (0R-3R). Changes in graft function were serially evaluated before, during, and in the resolving period after ACR.
No sign of rejection was seen in 268 biopsies (52.7%), minimal rejection (1R) in 202 biopsies (39.7%), and moderate rejection (2R) in 39 biopsies (7.7%); no patients had severe (3R) rejection. A significant difference in GLS was observed comparing the groups with 0R (-15.5%; 95% confidence interval, -16.2% to -14.2%), 1R (-15.3%; 95% confidence interval, -16.0% to -14.6%), and 2R (-13.8%; 95% confidence interval, -14.6% to -12.9%) rejection (P < .0001). GLS remained significantly reduced in the 2R group despite the exclusion of patients with impaired systolic function (ejection fraction < 50%), allograft vasculopathy, and late rejection (>2 years) after transplantation. In the serial assessment, GLS was decreasing significantly at the time of moderate 2R rejection and improved significantly in the resolving period. The traditional diastolic Doppler parameters, E-wave deceleration time and isovolumetric relaxation time, were unaffected by rejections, whereas the E/A and E/e' ratios were significantly higher in the 2R group (P = .004 and P = .01) compared with the 0R and 1R groups.
GLS is significantly reduced during moderate (2R) ACR and improves significantly in the resolving period. The present results provide encouraging evidence to consider the routine use of GLS as a marker of graft function involvement during ACR.
诊断和监测急性细胞排斥反应（ACR）是心脏移植患者监测的主要目标。本研究的目的是评估通过二维斑点追踪超声心动图测量的整体纵向应变（GLS）作为与ACR相关的移植物功能监测的非侵入性工具的价值。
研究人群包括2011年至2013年在一家机构接受活检及相应超声心动图检查的所有心脏移植患者（n = 64）。ACR根据国际心肺移植协会进行分类（0R - 3R）。在ACR之前、期间和消退期对移植物功能变化进行连续评估。
268次活检（52.7%）未见排斥迹象，202次活检（39.7%）为轻度排斥（1R），39次活检（7.7%）为中度排斥（2R）；无患者发生重度（3R）排斥。比较0R（-15.5%；95%置信区间，-16.2%至-14.2%）、1R（-15.3%；95%置信区间，-16.0%至-14.6%）和2R（-13.8%；95%置信区间，-14.6%至-12.9%）排斥组，观察到GLS有显著差异（P <.0001）。尽管排除了收缩功能受损（射血分数<50%）、同种异体血管病变和移植后晚期排斥（>2年）的患者，2R组的GLS仍显著降低。在连续评估中，中度2R排斥时GLS显著下降，消退期显著改善。传统的舒张期多普勒参数，E波减速时间和等容舒张时间，不受排斥影响，而2R组的E/A和E/e'比值与0R和1R组相比显著更高（P = 0.004和P = （此处原文有误，应为0.01））。
中度（2R）ACR期间GLS显著降低，消退期显著改善。目前的结果提供了令人鼓舞的证据，支持考虑将GLS常规用作ACR期间移植物功能受累的标志物。
