Hernandez Lazaro E, Shepard Charles W, Menk Jeremiah, Lilliam Valdes-Cruz, Ameduri Rebecca K
Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, Minnesota.
Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, Minnesota.
J Heart Lung Transplant. 2015 Sep;34(9):1190-7. doi: 10.1016/j.healun.2015.03.027. Epub 2015 Apr 11.
Serial invasive cardiac catheterization with endomyocardial biopsies (EMBs) is the current standard of reference for evaluation after orthotopic heart transplant (OHTx). We developed a novel, non-invasive echocardiographic index of global left ventricular relaxation (LVRI) and assessed its sensitivity, specificity and predictive value for detecting rejection compared with EMB results in a prospective study conducted from September 2012 through May 2014.
LVRI was calculated as the sum of diastolic tissue Doppler imaging (TDI) velocities (E') of the left ventricular lateral, septal and posterior walls divided by the percentage of left ventricular posterior wall (LVPW) thinning by M-mode. LVRI was measured in 47 OHTx patients and 50 patients with normal hearts. Of the 33 patients who underwent clinically indicated EMB, 22 patients had Grade 0R EMB, 6 had Grade 1R and 5 had Grade 2R to 3R biopsy results. Sensitivity, specificity and predictive value of LVRI for discriminating Grade 1R to 3R EMB were calculated. The LVRI was compared before and after OHTx rejection treatment and during the early and late post-transplant period. To characterize LVRI, 1-way analysis of variance was used to compare all groups, including non-OHTx patients.
LVRI was lower in patients with Grade 0R EMBs compared with non-OHTx patients. Patients with Grade 1R to 3R EMBs had lower LVRI than those with Grade 0R EMBs. LVRI recovered after treatment for rejection. LVRI appeared to normalize between 40 and 90 days post-transplantation. After 90 days, sensitivity was 100% and specificity was 90.9% for detecting patients with Grade 1R to 3R EMBs using an LVRI of 0.8.
LVRI, a novel, non-invasive TDI index of global left ventricular diastolic dysfunction, appears to be useful for detecting rejection in children beyond 3 months post-OHTx.
连续进行侵入性心内膜心肌活检（EMB）的心脏导管检查是目前原位心脏移植（OHTx）后评估的参考标准。我们开发了一种全新的、用于评估左心室整体舒张功能的非侵入性超声心动图指标（LVRI），并在2012年9月至2014年5月进行的一项前瞻性研究中，将其与EMB结果相比较，评估其在检测排斥反应方面的敏感性、特异性和预测价值。
LVRI通过左心室侧壁、室间隔和后壁舒张期组织多普勒成像（TDI）速度（E'）之和除以M型超声测得的左心室后壁（LVPW）变薄百分比来计算。对47例OHTx患者和50例心脏正常的患者进行LVRI测量。在33例接受临床指征EMB的患者中，22例患者EMB结果为0R级，6例为1R级，5例为2R至3R级活检结果。计算LVRI对鉴别1R至3R级EMB的敏感性、特异性和预测价值。比较OHTx排斥反应治疗前后以及移植后早期和晚期的LVRI。为了描述LVRI的特征，采用单因素方差分析对所有组进行比较，包括非OHTx患者。
0R级EMB患者的LVRI低于非OHTx患者。1R至3R级EMB患者的LVRI低于0R级EMB患者。排斥反应治疗后LVRI恢复。LVRI在移植后40至90天似乎恢复正常。90天后，使用LVRI为0.8检测1R至3R级EMB患者的敏感性为100%，特异性为90.9%。
LVRI是一种全新的、用于评估左心室舒张功能障碍的非侵入性TDI指标，似乎有助于检测OHTx术后3个月以上儿童的排斥反应。
