DeVore Adam D, Alenezi Fawaz, Krishnamoorthy Arun, Ersboll Mads, Samsky Marc D, Schulte Phillip J, Patel Chetan B, Rogers Joseph G, Milano Carmelo A, Velazquez Eric J, Khouri Michel G
Duke Clinical Research Institute, Durham, NC, USA.
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Clin Transplant. 2017 May;31(5). doi: 10.1111/ctr.12961. Epub 2017 Apr 8.
Cardiac allografts are routinely evaluated by left ventricular ejection fraction (LVEF) before and after transplantation. However, myocardial deformation analyses with LV global longitudinal strain (GLS) are more sensitive for detecting impaired LV myocardial systolic performance compared with LVEF.
We analyzed echocardiograms in 34 heart donor-recipient pairs transplanted at Duke University from 2000 to 2013. Assessments of allograft LV systolic function by LVEF and/or LV GLS were performed on echocardiograms obtained pre-explanation in donors and serially in corresponding recipients.
Donors had a median LVEF of 55% (25th, 75th percentile, 54% to 60%). Median donor LV GLS was -14.6% (-13.7 to -17.3%); LV GLS was abnormal (ie, >-16%) in 68% of donors. Post-transplantation, LV GLS was further impaired at 6 weeks (median -11.8%; -11.0 to -13.4%) and 3 months (median -11.4%; -10.3 to -13.9%) before recovering to pretransplant levels in follow-up. Median LVEF remained ≥50% throughout follow-up. We found no association between donor LV GLS and post-transplant outcomes, including all-cause hospitalization and mortality.
GLS demonstrates allograft LV systolic dysfunction in donors and recipients not detected by LVEF. The clinical implications of subclinical allograft dysfunction detected by LV GLS require further study.
心脏移植受者通常在移植前后通过左心室射血分数（LVEF）进行评估。然而，与LVEF相比，用左心室整体纵向应变（GLS）进行心肌变形分析在检测左心室心肌收缩功能受损方面更敏感。
我们分析了2000年至2013年在杜克大学进行移植的34对心脏供受者的超声心动图。通过LVEF和/或左心室GLS对移植前供者及相应受者系列超声心动图进行同种异体左心室收缩功能评估。
供者的LVEF中位数为55%（第25、75百分位数，54%至60%）。供者左心室GLS中位数为-14.6%（-13.7至-17.3%）；68%的供者左心室GLS异常（即＞-16%）。移植后，左心室GLS在6周时进一步受损（中位数-11.8%；-11.0至-13.4%），3个月时（中位数-11.4%；-10.3至-13.9%），之后在随访中恢复到移植前水平。整个随访期间LVEF中位数保持≥50%。我们发现供者左心室GLS与移植后结局之间无关联，包括全因住院和死亡率。
GLS显示了供者和受者中LVEF未检测到的同种异体左心室收缩功能障碍。左心室GLS检测到的亚临床同种异体移植功能障碍的临床意义需要进一步研究。
