Feingold Brian, Salgado Cláudia M, Reyes-Múgica Miguel, Drant Stacey E, Miller Susan A, Kennedy Mark, Kellman Peter, Schelbert Erik B, Wong Timothy C
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Pediatr Transplant. 2017 Aug;21(5). doi: 10.1111/petr.12986. Epub 2017 Jun 2.
Fibrosis is commonly described in heart allografts lost late after transplantation. CMR-derived ECV is a validated measure of DMF in native adult hearts that may predict heart failure and mortality. We explored associations of ECV with histologic myocardial fibrosis and clinical features after pediatric heart transplantation. Twenty-five recipients (7.0±6.3 years at transplant and 10.7±6.5 years post-transplant) were prospectively recruited for CMR and BNP measurement at the time of surveillance biopsy. All had normal ejection fractions and lacked heart failure symptoms. Fibrosis was quantified on biopsy after picrosirius red staining as CVF. ECV was quantified using contemporaneous hematocrit on basal and mid-short-axis slices. ECV was moderately correlated with CVF (r=.47; P=.019). We found no associations of ECV with hemodynamics, ischemic time, time since transplantation, or number of prior biopsies or acute rejections. Compared to healthy non-transplant controls, there was no significant difference in ECV (25.1±3.0 vs 23.7±2.0%, P=.09). Log-transformed BNP was correlated with ECV (recipients: r=.46, P=.02; recipients and controls: r=.45, P=.006). These findings suggest ECV quantifies DMF and relates to biological indicators of cardiac function after pediatric heart transplantation.
纤维化常见于移植后期失去功能的心脏同种异体移植物中。心脏磁共振成像（CMR）衍生的细胞外容积（ECV）是一种经证实的用于测量成年天然心脏中弥漫性心肌纤维化（DMF）的指标，可能预测心力衰竭和死亡率。我们探讨了小儿心脏移植后ECV与组织学心肌纤维化及临床特征之间的关联。前瞻性招募了25名接受者（移植时年龄为7.0±6.3岁，移植后为10.7±6.5岁），在监测活检时进行CMR和脑钠肽（BNP）测量。所有患者射血分数均正常且无心力衰竭症状。活检时经苦味酸天狼星红染色后将纤维化定量为胶原容积分数（CVF）。使用同期基础和短轴中段切片上的血细胞比容对ECV进行定量。ECV与CVF呈中度相关（r = 0.47；P = 0.019）。我们发现ECV与血流动力学、缺血时间、移植后的时间、既往活检次数或急性排斥反应均无关联。与健康的非移植对照相比，ECV无显著差异（25.1±3.0% 对 23.7±2.0%，P = 0.09）。对数转换后的BNP与ECV相关（接受者：r = 0.46，P = 0.02；接受者和对照：r = 0.45，P = 0.006）。这些发现表明ECV可对DMF进行定量，并与小儿心脏移植后心脏功能的生物学指标相关。
