Desruennes M, Corcos T, Lechat P, Rossant P, Léger P, Vaissier E, Pavie A, Gandjbakhch I, Cabrol A, Cabrol C
Service de chirurgie thoracique et cardiovasculaire, Groupe hospitalier Pitié-Salpêtrière, Paris, France.
Arch Mal Coeur Vaiss. 1988 Feb;81(2):193-8.
In order to study abnormalities of left ventricular diastolic function (LVDF) in heart transplant patients and their possible association with graft rejection, 21 patients who had recently undergone orthotopic heart transplantation were evaluated prospectively, on the day of endomyocardial biopsy, by pulsed and continuous Doppler echocardiography (DEC). Investigation of the LVDF consisted of pulsed DEC of the mitral valve in apical projection (4 cavities) with measurement of isovolumetric relaxation time (IVR), peak velocity of rapid ventricular filling (E), peak velocity of graft atrial contraction (A) and transmitral gradient decrease half-time (mitral T1/2). Each patients had 5 DEC examinations on average over a 2-month period. In patients with subsevere to severe rejection mitral T1/2 decreased significantly from 76.46 +/- 11.6 ms in the absence of rejection to 47 +/- 13.7 ms during rejection (P less than 0.001). When mitral T1/2 decreased by 25 p. 100 or more between two successive DEC, rejection was present in 89 p. 100 of the cases. It is concluded that Doppler echocardiographic studies of left ventricular diastolic function provide useful information in the follow-up of heart transplant recipients and offer hopes, in a not too distant future, of non-invasive detection of cardiac graft rejection.
为研究心脏移植患者左心室舒张功能（LVDF）异常及其与移植排斥反应的可能关联，对21例近期接受原位心脏移植的患者在心肌内膜活检当日采用脉冲和连续多普勒超声心动图（DEC）进行前瞻性评估。LVDF检查包括在心尖四腔心切面用脉冲DEC测量二尖瓣等容舒张时间（IVR）、快速心室充盈峰值速度（E）、移植心房收缩峰值速度（A）以及二尖瓣跨瓣压差下降一半时间（二尖瓣T1/2）。每位患者在2个月内平均接受5次DEC检查。在发生轻至重度排斥反应的患者中，二尖瓣T1/2从无排斥反应时的76.46±11.6毫秒显著降至排斥反应时的47±13.7毫秒（P＜0.001）。当两次连续DEC检查之间二尖瓣T1/2下降25%或更多时，89%的病例存在排斥反应。结论是，左心室舒张功能的多普勒超声心动图研究为心脏移植受者的随访提供了有用信息，并有望在不久的将来实现对心脏移植排斥反应的无创检测。
