Wengenmayer Tobias, Stephan Anna, Grundmann Sebastian, Föll Daniela, Beyersdorf Friedhelm, Bode Christoph, Geibel Annette
Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
Thorac Cardiovasc Surg. 2017 Aug;65(5):415-422. doi: 10.1055/s-0036-1597591. Epub 2016 Dec 28.
Global longitudinal strain is reduced in heart transplant recipients, but little is known about regional contractility of the transplanted heart. Moreover, it is unclear if factors such as time after transplant and ischemic time have an influence on regional contractility. To test for regional changes in myocardial deformation, we assessed regional myocardial deformation using three-dimensional speckle tracking echocardiography in heart transplant recipients and controls. Global and regional longitudinal, circumferential, and radial strain was assessed in 51 heart transplant recipients and a control group of healthy individuals ( = 26). Moreover, we correlated regional contractility with clinical characteristics and compared subgroups of heart transplant recipients with normal ( = 32) and reduced left ventricular ejection fraction ( = 32). Global longitudinal and circumferential strain was significantly reduced in all heart transplant recipients, as well as in the transplant group with normal ejection fraction compared with the control group ( < 0.001). Global radial strain (GRS) was elevated in both transplant groups, but was significantly higher in transplant recipients with normal ejection fraction compared with the control group ( < 0.01). Both transplant groups revealed lower longitudinal and circumferential strain values in the mid- and apical regions ( < 0.001), whereas longitudinal and circumferential strain was higher in the basal region ( < 0.01). In both groups, transplanted hearts showed increased radial strain in the basal ( < 0.05, < 0.01) and midregions ( = 0.22; < 0.01) and did not differ in the apical regions. Cold ischemic time (150 ± 12.6 minutes) was independently associated with reduction in circumferential strain. Time since transplantation ranging from 18 days to 21 years had no effect on myocardial deformation parameters. Left ventricular mechanics in transplanted hearts display significantly different systolic deformation patterns than native hearts. Strain capability forms a regional gradient from the base toward the apex. The presence of a time-independent deformation pattern and the correlation with cold ischemic time suggest damage induced by the transplantation itself. These findings might be important for understanding pseudo-abnormal echocardiograms in heart transplant patients.
心脏移植受者的整体纵向应变降低，但对于移植心脏的局部收缩功能了解甚少。此外，尚不清楚移植后时间和缺血时间等因素是否会对局部收缩功能产生影响。为了检测心肌变形的局部变化，我们使用三维斑点追踪超声心动图对心脏移植受者和对照组进行了局部心肌变形评估。在51名心脏移植受者和一组健康个体对照组（n = 26）中评估了整体和局部的纵向、圆周和径向应变。此外，我们将局部收缩功能与临床特征进行了关联，并比较了左心室射血分数正常（n = 32）和降低（n = 32）的心脏移植受者亚组。与对照组相比，所有心脏移植受者以及射血分数正常的移植组的整体纵向和圆周应变均显著降低（P < 0.001）。两个移植组的整体径向应变（GRS）均升高，但射血分数正常的移植受者与对照组相比显著更高（P < 0.01）。两个移植组在心肌中层和心尖区域的纵向和圆周应变值均较低（P < 0.001），而在基底区域纵向和圆周应变较高（P < 0.01）。在两组中，移植心脏在基底（P < 0.05，P < 0.01）和中层区域（P = 0.22；P < 0.01）的径向应变增加，在心尖区域无差异。冷缺血时间（150 ± 12.6分钟）与圆周应变降低独立相关。移植后18天至21年的时间对心肌变形参数无影响。移植心脏的左心室力学表现出与天然心脏显著不同的收缩期变形模式。应变能力从基底向心尖形成局部梯度。存在与时间无关的变形模式以及与冷缺血时间的相关性表明移植本身会造成损伤。这些发现对于理解心脏移植患者的假性异常超声心动图可能很重要。
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