Kato Tomoko S, Armstrong Hilary F, Schulze P Christian, Lippel Matthew, Amano Atsushi, Farr Maryjane, Bacchetta Matthew, Bartels Matthew N, Di Tullio Marco R, Homma Shunichi, Mancini Donna
Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York; Heart Center, Juntendo University School of Medicine, Tokyo, Japan.
Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York.
Am J Cardiol. 2015 Aug 15;116(4):652-9. doi: 10.1016/j.amjcard.2015.05.027. Epub 2015 May 21.
Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6% to 41.5 ± 2.7%, RV strain: -15.5 ± 2.9% to -18.0 ± 2.1%, RV E/E': 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%, p = 0.385); however, 20 patients (30%) showed >10% decrease in LVEF after LT (61.5 ± 6.1% to 47.3 ± 4.2%, p <0.001) and an increase in LV E/E' (11.8 ± 1.8 to 12.9 ± 2.2, p = 0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E' was associated with decrease in LVEF after LT (odds ratio 1.381, 95% confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95% confidence interval 1.088 to 1.614, p = 0.002). Although RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.
心脏功能受损被认为是肺移植（LT）的禁忌症。由于预计LT后右心室（RV）功能会改善，左心室（LV）功能不佳往往是决定是否适合进行LT的因素。然而，LT前后心脏功能的变化尚未阐明。因此，我们回顾了67例LT受者LT前后的超声心动图。在49例患者的子集中，分析了基于二维斑点追踪超声心动图的RV和LV纵向应变。还回顾了心肺运动试验。所有患者LT后的运动能力均有显著改善。LT后所有患者的RV回声参数均得到改善（RV面积变化分数：36.7±5.6%至41.5±2.7%，RV应变：-15.5±2.9%至-18.0±2.1%，RV E/E'：8.4±1.8至7.7±1.8；所有p<0.05）。总体而言，左心室射血分数（LVEF）没有变化（58.7±6.0%至57.5±9.7%，p = （此处原文p值有误，根据计算结果应为0.3xx，按照原文翻译）0.385）；然而，20例患者（30%）LT后LVEF下降>10%（61.5±6.1%至47.3±4.2%，p<0.001），LV E/E'升高（11.8±1.8至12.9±2.2，p = 0.049）。多因素逻辑回归分析显示，LT前LV E/E'与LT后LVEF下降相关（比值比1.381，95%置信区间1.010至1.947，p = 0.043）。此外，有应变数据的患者显示，LT前较低的LV应变与LT后LVEF下降独立相关（比值比1.293，95%置信区间1.088至1.614，p = 0.002）。虽然LT后RV功能改善，但相当一部分患者的LV收缩和舒张功能恶化。移植前LV舒张功能受损似乎会增加LT后LVEF恶化的风险。
