Wisotzkey Bethany L, Jorgensen Neal W, Albers Erin L, Kemna Mariska S, Boucek Robert J, Kronmal Richard A, Law Yuk M, Bhat Aarti H
Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA.
Pediatr Transplant. 2017 Jun;21(4). doi: 10.1111/petr.12909. Epub 2017 Mar 10.
Evaluation of myocardial mechanics after heart transplant is important in monitoring allograft function and identifying rejection. Speckle tracking global longitudinal strain (GLS) may be more sensitive to early regional changes from rejection. This study aimed to determine feasibility of GLS in pediatric hearts during surveillance echocardiograms, compare their GLS to published norms (-18% to -22%), and assess association of GLS with other indices of graft function. Retrospective review of transplant echocardiograms from 2013 to 2014. Philips QLAB was used for post-acquisition GLS analysis. Multiple linear regression was used to assess the association of GLS with echocardiographic/catheterization indices, and B-type natriuretic peptide (BNP). Forty-seven patients (84 studies) were included. Calculation of GLS was feasible in 82 studies (97%) with inter- and intra-observer variability of 0.71 and 0.69. Patients (n=9) with rejection had GLS of -16.4% (SD=3.5%) compared to those without [-16.8% (SD=3.7%)]. GLS worsened linearly with increasing Ln(BNP) (P=<.001), left ventricular volume in diastole (P=<.001), septal a' wave (P=<.001), and pulmonary capillary wedge pressure (P=<.001). Speckle tracking-based GLS is feasible and reproducible in pediatric heart recipients and is reduced at baseline. The role of GLS and BNP in detecting early systolic dysfunction warrants further investigation.
心脏移植后心肌力学评估对于监测同种异体移植功能和识别排斥反应至关重要。斑点追踪整体纵向应变（GLS）可能对排斥反应引起的早期局部变化更为敏感。本研究旨在确定GLS在儿科心脏监测超声心动图中的可行性，将其GLS与已发表的标准值（-18%至-22%）进行比较，并评估GLS与移植功能其他指标之间的关联。回顾性分析2013年至2014年的移植超声心动图。采用飞利浦QLAB进行采集后GLS分析。使用多元线性回归评估GLS与超声心动图/心导管检查指标以及B型利钠肽（BNP）之间的关联。纳入47例患者（84项研究）。82项研究（97%）中GLS计算可行，观察者间和观察者内变异性分别为0.71和0.69。有排斥反应的患者（n = 9）GLS为-16.4%（标准差=3.5%），而无排斥反应的患者为[-16.8%（标准差=3.7%）]。GLS随Ln(BNP)升高（P<0.001）、舒张末期左心室容积增大（P<0.001）（此处原文可能有误，推测为舒张末期左心室容积增大更符合逻辑）、室间隔a'波增大（P<0.001）以及肺毛细血管楔压升高（P<0.001）呈线性恶化。基于斑点追踪的GLS在儿科心脏移植受者中可行且可重复，且在基线时降低。GLS和BNP在检测早期收缩功能障碍中的作用值得进一步研究。 （注：原文中“left ventricular volume in diastole (P=<.001)”可能有误，根据上下文推测此处应为舒张末期左心室容积增大，翻译时做了相应调整）
