Schroeder Luke W, Chowdhury Shahryar M, Burnette Ali L, Kavarana Minoo N, Hamilton Baker G, Savage Andrew J, Atz Andrew M, Butts Ryan J
Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA.
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
Pediatr Cardiol. 2018 Feb;39(2):324-328. doi: 10.1007/s00246-017-1758-7. Epub 2017 Oct 31.
The purpose of this study was to investigate the associations between clinical factors and cardiac function as measured by pressure-volume loops (PVLs) in a pediatric heart transplant cohort.
Patients (age < 20 years) who underwent heart transplantation presenting for a clinically indicated catheterization were enrolled. PVLs were recorded using microconductance catheters (CD Leycom, Zoetermeer, Netherlands). Demographic data, serum B-type natriuretic peptide (BNP), time from transplant, ischemic time, presence of transplant coronary artery disease, donor-specific antibodies, and history of rejection were recorded at the time of catheterization. PVL data included contractility indices: end-systolic elastance and preload recruitable stroke work; ventricular-arterial coupling index; ventricular stiffness constant, Beta; and isovolumic relaxation time constant, tau. Associations between PVL measures and clinical data were investigated using non-parametric statistical tests.
A total of 18 patients were enrolled. Median age was 8.7 years (IQR 5-14 years). There were ten males and eight females. Six patients had a history of rejection and ten had positive donor-specific antibodies. There was no transplant coronary artery disease. Median BNP was 100 pg/mL (IQR 46-140). Time from transplant to PVL obtained during catheterization procedure was 4.1 years (IQR 1.7-7.8 year). No single clinical characteristic was statistically significant when correlated with PVL data. However, longer ischemic time was associated with worse Beta (r = 0.49, p = 0.05).
Our study found that longer ischemic times are associated with increased left ventricular stiffness. No other single clinical variable is associated with cardiac dysfunction as determined by PVL analysis.
本研究旨在调查儿科心脏移植队列中临床因素与通过压力-容积环（PVL）测量的心脏功能之间的关联。
纳入因临床指征行导管插入术而接受心脏移植的患者（年龄<20岁）。使用微电导导管（CD Leycom，荷兰祖特梅尔）记录PVL。在导管插入术时记录人口统计学数据、血清B型利钠肽（BNP）、移植时间、缺血时间、移植冠状动脉疾病的存在情况、供体特异性抗体以及排斥反应史。PVL数据包括收缩性指标：收缩末期弹性和可募集前负荷搏功；心室-动脉耦合指数；心室僵硬度常数β；以及等容舒张时间常数τ。使用非参数统计检验研究PVL测量值与临床数据之间的关联。
共纳入18例患者。中位年龄为8.7岁（四分位间距5 - 14岁）。男性10例，女性8例。6例患者有排斥反应史，10例有供体特异性抗体阳性。无移植冠状动脉疾病。中位BNP为100 pg/mL（四分位间距46 - 140）。从移植到导管插入术期间获得PVL的时间为4.1年（四分位间距1.7 - 7.8年）。与PVL数据相关时，没有单一临床特征具有统计学意义。然而，较长的缺血时间与更差的β相关（r = 0.49, p = 0.05）。
我们的研究发现，较长的缺血时间与左心室僵硬度增加有关。PVL分析确定，没有其他单一临床变量与心脏功能障碍相关。
