Ruiz-Ortiz Martín, Rodriguez-Diego Sara, Delgado Mónica, Kim Jiwon, Weinsaft Jonathan W, Ortega Rosa, Carnero Lucía, Sánchez José J, Carrasco Francisco, López-Aguilera José, López-Granados Amador, Arizón José M, Paredes Nick, Oneto-Fernandez Jesús, Pan Manuel, Mesa Dolores
Cardiology Department, Reina Sofia University Hospital, Cordoba, Spain.
Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA.
Echocardiography. 2019 Dec;36(12):2185-2194. doi: 10.1111/echo.14544. Epub 2019 Nov 22.
Our objective was to investigate the impact of inter-vendor variability in the ability of myocardial strain analysis to detect acute cellular rejection (ACR) in heart transplant recipients.
We performed serial echocardiographic examinations in 18 consecutive adult heart transplanted patients, in their first year post-transplantation, within 3 hours of the routine surveillance endomyocardial biopsies (EMB) in a single center. Myocardial strain was analyzed using two software in two different institutions, and inter-vendor variability of strain values and its association with ACR (any grade or grade ≥2R) was investigated. The parameter of comparison was the peak value of the average curve of strain during the entire cardiac cycle.
A total of 147 pairs of EMB-echocardiogram were performed, 65 with no ACR, 63 with ACR grade 1R, and 19 with ACR grade ≥2R. Intra-class correlation coefficients for left ventricle longitudinal, radial, and circumferential strain were 0.38, 0.39, and 0.77, respectively, and 0.32 for right ventricular longitudinal strain. Neither software found significant association of left ventricular longitudinal strain with rejection. Grade ≥2R ACR was associated with left ventricular circumferential strain measured with the first software and with left ventricular radial strain with the other; and ACR of any grade was only significantly associated with right ventricle longitudinal strain measured with the first software.
Inter-vendor reproducibility of strain values was low in this study. Some strain parameters were associated to ACR, although these results were inconsistent between two commercially available software. Specific validation of each software is warranted for this clinical indication.
我们的目标是研究不同供应商的心肌应变分析能力在检测心脏移植受者急性细胞排斥反应（ACR）方面的差异。
我们对18例连续的成年心脏移植患者在移植后的第一年进行了系列超声心动图检查，检查在单一中心常规监测心内膜心肌活检（EMB）的3小时内进行。使用两个不同机构的两种软件分析心肌应变，并研究应变值的供应商间差异及其与ACR（任何级别或≥2R级）的关联。比较参数为整个心动周期中应变平均曲线的峰值。
共进行了147对EMB-超声心动图检查，其中65例无ACR，63例为1R级ACR，19例为≥2R级ACR。左心室纵向、径向和圆周应变的组内相关系数分别为0.38、0.39和0.77，右心室纵向应变的组内相关系数为0.32。两种软件均未发现左心室纵向应变与排斥反应有显著关联。≥2R级ACR与第一种软件测量的左心室圆周应变以及另一种软件测量的左心室径向应变相关；任何级别的ACR仅与第一种软件测量的右心室纵向应变显著相关。
本研究中应变值的供应商间再现性较低。一些应变参数与ACR相关，尽管这些结果在两种商用软件之间并不一致。针对这一临床适应症，每种软件都需要进行特定的验证。
