Cardiology Department, University of Baskent, Ankara, Turkey.
Cardiothoracic Surgery Department, University of Baskent, Ankara, Turkey.
Am J Cardiol. 2020 Dec 15;137:63-70. doi: 10.1016/j.amjcard.2020.09.037. Epub 2020 Sep 28.
Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic, and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pretransplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared with pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8 ± 4.3 mm Hg (range: 4 to 25 mm Hg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e'), were different between studies with normal (n = 47) and elevated PCWP (n = 27). Area Under Curve for GLS (0.932*), E/e' (0.849*), and systolic SR (0.848*) (*p <0.0001) were more accurate than traditional parameters for predicting PCWP>12 mm Hg. GLS, systolic SR and E/e' remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e' was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e' tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e' provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP.
传统参数对于评估正交心脏移植（OHT）受者的左心室充盈压（LVFP）具有有限的价值。我们假设，在 LVFP 升高的 OHT 受者中，整体纵向应变（GLS）、舒张和收缩应变率（SR）会降低，并且可以克服传统参数的局限性。我们连续研究了接受心内膜心肌活检的 OHT 患者，并回顾性地研究了符合相同方案的移植前研究。进行了全面的超声心动图应变测量。结果与右心导管插入术获得的肺毛细血管楔压（PCWP）进行了比较，该研究是在超声心动图研究之后立即进行的。共对 50 例 OHT 受者进行了 74 项研究。平均 PWCP 为 11.8 ± 4.3mmHg（范围：4 至 25mmHg）。尽管左心房容积指数、二尖瓣流入速度、瓣环速度及其比值（E/e'）在正常（n=47）和 PCWP 升高（n=27）的研究之间有所不同，但几个参数（E/e'除外）。GLS（0.932*）、E/e'（0.849*）和收缩 SR（0.848*）（*p<0.0001）的曲线下面积对于预测 PCWP>12mmHg 比传统参数更准确。GLS、收缩 SR 和 E/e'无论左心室射血分数和同种异体血管病变如何，仍然准确预测 PWCP。GLS 和 E/e'的变化准确地反映了 PCWP 的变化。总之，传统的舒张功能指数在 OHT 受者中表现不佳，而 GLS 和 E/e'提供了可靠的 LVFP 方法，无论射血分数和同种异体血管病变如何。这些参数也可以很好地跟踪 LVFP 的变化。
