Iturralde M, Novitzky D, Cooper D K, Rose A G, Boniaszczuk J, Smith J A, Reichart B, Isaacs S
Department of Nuclear Medicine, H.F. Verwoerd Hospital, Pretoria, Republic of South Africa.
Semin Nucl Med. 1988 Jul;18(3):221-40. doi: 10.1016/s0001-2998(88)80030-8.
Heart transplantation is, today, an accepted and recommended modality in the management of selected patients suffering from terminal heart disease. However, acute rejection and infection remain the major complications of this operation. Serial endomyocardial biopsy (EB), considered as the standard for diagnosis of cardiac rejection, is an invasive and delicate operation, not free of complications, even when done by skilled personnel in specialized centers. The object of this study was to compare and correlate between radionuclide ventriculography (RNV) and the histologic findings of EB. Furthermore, to validate the use of nuclear cardiology techniques that allow noninvasive, reliable, and rapid quantitation of ventricular function and myocardial perfusion for the diagnosis and management of rejection in patients with heart transplants. Radionuclide studies of left ventricular function were performed in 3 heterotopic heart transplant patients (HHT) with long term survival and early after the operation in 5 patients with HHT, 12 orthotopic heart transplants (OHT) and in 2 heart and lung transplants (HLT). Simultaneous EBs were performed in the early posttransplant patients and a histologic score for acute rejection was obtained. First pass (FP) and multigated equilibrium blood pool ventriculography, using the in vivo 99mTc-labelling of RBCs was used to measure left ventricular volumes (LVV) such as stroke volume (SV), end-diastolic volume (EDV), end-systolic volume (ESV), and both global and regional ejection fraction (EF, REF). The histological grading of acute rejection was classified into four groups: (1) no rejection, (2) mild rejection, (3) moderate rejection, and (4) severe rejection. The median of each LVV parameter was calculated and correlated with the EB using a nonparametric one way analysis of variance. A percentage change of LVVs was used rather than the difference of the calculated LVVs. During moderate acute rejection, SV had the highest correlation in P less than 0.004, followed by the EDV (P less than 0.05), and finally ESV (P less than 0.02). During severe acute rejection the correlation was SV (P less than 0.0008), EDV (P less than 0.001), and ESV (P less than 0.006). Myocardial perfusion scintigraphy using 201T1 was performed in the HHT patients, although, at this stage we have not attempted a correlation with the histologic findings. In one patient with long term survival OHT, increased 131I-metaiodobenzylguanidine (MIBG) myocardial uptake was evident during a rejection episode.
如今，心脏移植是治疗某些终末期心脏病患者公认且推荐的治疗方式。然而，急性排斥反应和感染仍是该手术的主要并发症。连续心内膜心肌活检（EB）被视为诊断心脏排斥反应的标准，但它是一种侵入性且精细的操作，即便由专业中心的技术熟练人员进行，也并非没有并发症。本研究的目的是比较放射性核素心室造影（RNV）与EB的组织学检查结果，并建立两者之间的关联。此外，要验证核心脏病学技术在心脏移植患者排斥反应诊断和管理中的应用，该技术可实现心室功能和心肌灌注的无创、可靠且快速定量分析。对3例长期存活的异位心脏移植（HHT）患者、5例术后早期的HHT患者、12例原位心脏移植（OHT）患者以及2例心肺移植（HLT）患者进行了左心室功能的放射性核素研究。对移植后早期的患者同时进行了EB检查，并获得了急性排斥反应的组织学评分。使用体内99mTc标记红细胞的首次通过（FP）和多门控平衡血池心室造影来测量左心室容积（LVV），如每搏输出量（SV）、舒张末期容积（EDV）、收缩末期容积（ESV）以及整体和局部射血分数（EF、REF）。急性排斥反应的组织学分级分为四组：（1）无排斥反应，（2）轻度排斥反应，（3）中度排斥反应，（4）重度排斥反应。计算每个LVV参数的中位数，并使用非参数单因素方差分析将其与EB结果进行关联。使用LVV的百分比变化而非计算出的LVV差值。在中度急性排斥反应期间，SV的相关性最高，P值小于0.004，其次是EDV（P值小于0.05），最后是ESV（P值小于0.02）。在重度急性排斥反应期间，相关性依次为SV（P值小于0.0008）、EDV（P值小于0.001）和ESV（P值小于0.006）。对HHT患者进行了使用201T1的心肌灌注显像，不过在此阶段我们尚未尝试将其与组织学检查结果进行关联。在1例长期存活的OHT患者中，在一次排斥反应发作期间，131I - 间碘苄胍（MIBG）心肌摄取明显增加。
