Pediatric Cardiology and Arrhythmology Unit, Bambino Gesù Children Hospital-IRCCS, Rome, Italy.
Pediatric Cardiology and Arrhythmology Unit, Bambino Gesù Children Hospital-IRCCS, Rome, Italy.
J Heart Lung Transplant. 2017 May;36(5):559-566. doi: 10.1016/j.healun.2016.11.007. Epub 2016 Dec 1.
Transplanted heart dysfunction is a serious life-threatening condition in pediatric transplant recipients. Several studies have focused on echocardiographic detection of early signs of cardiac dysfunction in this population. We evaluated advanced echocardiographic indices of cardiac function in a large sample of children and young adults with heart transplants with apparently normal cardiac function.
The study included 60 patients with normal ejection fraction with transplantation performed at pediatric age between 1986 and 2014 and 60 healthy control subjects. All patients and control subjects underwent a complete transthoracic echocardiographic examination including tissue Doppler analysis, 2-dimensional speckle tracking, and 3-dimensional echocardiography. Two-dimensional speckle tracking analysis was used to obtain measures of left ventricular (LV) radial, circumferential, and longitudinal strain and to derive LV twist and torsion from basal and apical rotation. Three-dimensional echocardiography was used to measure LV volumes and ejection fraction and to evaluate LV systolic synchrony.
No differences were observed between groups in LV volumes, left atrial diameters, LV ejection fraction, or right ventricular fractional area change. However, patients showed lower values of longitudinal systolic excursion of valvular planes at both the mitral and the tricuspid valve level as well as higher mitral E/E' ratio. Cardiac radial strain was similar between groups; a significant net reduction in both global left and right ventricular longitudinal strain and LV global circumferential strain could be observed between the 2 groups (all p < 0.05). In addition, reduced LV twist and torsion was found in patients compared with healthy control subjects (p < 0.01) mainly owing to a significant reduction in basal rotation (-2.4° vs -3.8°; p < 0.05). none of the control subjects demonstrated LV dyssynchrony, whereas systolic dyssynchrony was observed in 20% of heart transplant recipients.
Even in the absence of signs of graft failure and in the presence of a normal ejection fraction, transplanted hearts show a significant reduction in biventricular function. Additional prognostic studies are needed to establish whether these abnormalities predict development of overt heart failure.
移植心脏功能障碍是儿科移植受者中一种严重的危及生命的情况。有几项研究集中在超声心动图检测该人群中心脏功能障碍的早期迹象。我们评估了大量心脏移植后心脏功能正常的儿童和年轻成人的先进超声心动图心脏功能指标。
该研究纳入了 60 名在 1986 年至 2014 年期间在儿科进行心脏移植且射血分数正常的患者和 60 名健康对照者。所有患者和对照者均接受了完整的经胸超声心动图检查，包括组织多普勒分析、二维斑点追踪和三维超声心动图。二维斑点追踪分析用于获得左心室（LV）径向、周向和纵向应变的测量值，并从基底和心尖旋转获得 LV 扭转和扭转。三维超声心动图用于测量 LV 容积和射血分数，并评估 LV 收缩同步性。
两组在 LV 容积、左心房直径、LV 射血分数或右心室分数区域变化方面无差异。然而，患者在二尖瓣和三尖瓣水平的瓣环平面纵向收缩位移较低，而二尖瓣 E/E'比值较高。两组间心脏径向应变相似；两组间均可见整体左室和右室纵向应变和 LV 整体周向应变明显降低（均 P < 0.05）。此外，与健康对照组相比，患者的 LV 扭转和扭转明显减少（P < 0.01），主要是由于基底旋转减少（-2.4°比-3.8°；P < 0.05）。对照组中无 LV 不同步，而 20%的心脏移植受者存在收缩不同步。
即使在没有移植物衰竭迹象且射血分数正常的情况下，移植心脏也表现出双心室功能明显下降。需要进一步的预后研究来确定这些异常是否预示着明显的心衰发生。
