心脏磁共振 T1 mapping 与超声心动图多维斑点追踪应变在心脏移植受者急性细胞排斥反应检测中的应用。
T1 Mapping by Cardiac Magnetic Resonance and Multidimensional Speckle-Tracking Strain by Echocardiography for the Detection of Acute Cellular Rejection in Cardiac Allograft Recipients.
机构信息
Cardiology Department, University of Baskent, Ankara, Turkey.
Radiology Department, University of Hacettepe, Ankara, Turkey.
出版信息
JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1601-1614. doi: 10.1016/j.jcmg.2018.02.022. Epub 2018 Apr 18.
OBJECTIVES
The aim of this study was to test the hypothesis that echocardiographic strain imaging, by tracking subtle alterations in myocardial function, and cardiac magnetic resonance T1 mapping, by quantifying tissue properties, are useful and complement each other to detect acute cellular rejection in heart transplant recipients.
BACKGROUND
Noninvasive alternatives to endomyocardial biopsy are highly desirable to monitor acute cellular rejection.
METHODS
Surveillance endomyocardial biopsies, catheterizations, and echocardiograms performed serially according to institutional protocol since transplantation were retrospectively reviewed. Sixteen-segment global longitudinal strain (GLS) and circumferential strain were measured before, during, and after the first rejection and at 2 time points for patients without rejection using Velocity Vector Imaging for the first part of the study. The second part, with cardiac magnetic resonance added to the protocol, served to validate previously derived strain cutoffs, examine the progression of strain over time, and to determine the accuracy of strain and T1 measurements to define acute cellular rejection. All tests were performed within 48 h.
RESULTS
Median time to first rejection (16 grade 1 rejection, 15 grade ≥2 rejection) was 3 months (interquartile range: 3 to 36 months) in 49 patients. GLS and global circumferential strain worsened significantly during grade 1 rejection and ≥2 rejection and were independent predictors of any rejection. In the second part of the study, T1 time ≥1,090 ms, extracellular volume ≥32%, GLS >-14%, and global circumferential strain ≥-24% had 100% sensitivity and 100% negative predictive value to define grade ≥2 rejection with 70%, 63%, 55%, and 35% positive predictive values, respectively. The combination of GLS >-16% and T1 time ≥1,060 ms defined grade 1 rejection with 91% sensitivity and 92% negative predictive value. After successful treatment, T1 times decreased significantly.
CONCLUSIONS
T1 mapping and echocardiographic GLS can serve to guide endomyocardial biopsy selectively.
目的
本研究旨在验证假设，即通过跟踪心肌功能的细微变化进行超声心动图应变成像，以及通过量化组织特性进行心脏磁共振 T1 映射，是有用的且相互补充，可以检测心脏移植受者中的急性细胞排斥。
背景
非常需要替代心内膜心肌活检的非侵入性替代方法来监测急性细胞排斥。
方法
根据机构方案，回顾性分析了自移植以来连续进行的监测心内膜心肌活检、导管插入术和超声心动图。使用 Velocity Vector Imaging 进行了研究的第一部分，在第一次排斥反应之前、期间和之后以及无排斥反应的患者的 2 个时间点测量了 16 节段的整体纵向应变（GLS）和周向应变。第二部分，在方案中添加心脏磁共振，用于验证之前推导的应变截止值，检查应变随时间的进展，并确定应变和 T1 测量的准确性以定义急性细胞排斥。所有测试均在 48 小时内进行。
结果
49 例患者中，首次排斥反应的中位时间为 3 个月（四分位距：3 至 36 个月），其中包括 16 例 1 级排斥反应和 15 例≥2 级排斥反应。GLS 和整体周向应变在 1 级和≥2 级排斥反应期间明显恶化，是任何排斥反应的独立预测因子。在研究的第二部分中，T1 时间≥1090 ms、细胞外容积≥32%、GLS＞-14%和整体周向应变≥-24% 对定义≥2 级排斥反应的灵敏度和阴性预测值均为 100%，阳性预测值分别为 70%、63%、55%和 35%。GLS＞-16%和 T1 时间≥1060 ms 的组合定义 1 级排斥反应的灵敏度为 91%，阴性预测值为 92%。经成功治疗后，T1 时间显著下降。
结论
T1 映射和超声心动图 GLS 可用于有选择地指导心内膜心肌活检。
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