Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Division of Pulmonary Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Transplant. 2021 Mar;25(2):e13858. doi: 10.1111/petr.13858. Epub 2020 Oct 19.
The importance of preoperative cardiac function in pediatric lung transplantation is unknown. We hypothesized that worse preoperative right ventricular (RV) systolic and worse left ventricular (LV) diastolic function would be associated with a higher risk of primary graft dysfunction grade 3 (PGD 3) between 48 and 72 hours. We performed a single center, retrospective pilot study of children (<18 years) who had echocardiograms <1 year prior to lung transplantation between 2006 and 2019. Conventional and strain echocardiography parameters were measured, and PGD was graded. Area under the receiver operating characteristic (AUROC) curves and logistic regression were performed. Forty-one patients were included; 14 (34%) developed PGD 3 and were more likely to have pulmonary hypertension (PH) as the indication for transplant (P = .005). PGD 3 patients had worse RV global longitudinal strain (P = .01), RV free wall strain (FWS) (P = .003), RV fractional area change (P = .005), E/e' (P = .01) and lateral e' velocity (P = .004) but not tricuspid annular plane systolic excursion (P = .61). RV FWS (AUROC 0.79, 95% CI 0.62-0.95) and lateral e' velocity (AUROC 0.87, 95% CI 0.68-1.00) best discriminated PGD 3 development and showed the strongest association with PGD 3 (RV FWS OR 3.87 [95% CI 1.59-9.43], P = .003; lateral e' velocity OR 0.10 [95% CI 0.01-0.70], P = .02). These associations remained when separately adjusting for age, weight, primary PH diagnosis, ischemic time, and bypass time. In this pilot study, worse preoperative RV systolic and worse LV diastolic function were associated with PGD 3 and may be modifiable recipient risk factors in pediatric lung transplantation.
术前心功能在小儿肺移植中的重要性尚不清楚。我们假设术前右心室（RV）收缩功能较差和左心室（LV）舒张功能较差与 48 至 72 小时内原发性移植物功能障碍 3 级（PGD3）的风险增加相关。我们进行了一项单中心回顾性试点研究，纳入了 2006 年至 2019 年间在肺移植前 1 年内进行超声心动图检查的儿童（<18 岁）。测量了常规和应变超声心动图参数，并对 PGD 进行分级。进行了接收者操作特征（ROC）曲线下面积（AUROC）和逻辑回归分析。共纳入 41 例患者，其中 14 例（34%）发生 PGD3，更有可能因肺动脉高压（PH）而作为移植适应证（P=0.005）。PGD3 患者的 RV 整体纵向应变（P=0.01）、RV 游离壁应变（P=0.003）、RV 面积分数变化（P=0.005）、E/e'（P=0.01）和侧壁 e'速度（P=0.004）更差，但三尖瓣环平面收缩期位移（P=0.61）无差异。RV 游离壁应变（AUROC 0.79，95%CI 0.62-0.95）和侧壁 e'速度（AUROC 0.87，95%CI 0.68-1.00）最佳区分了 PGD3 的发生，并且与 PGD3 相关性最强（RV 游离壁应变 OR 3.87 [95%CI 1.59-9.43]，P=0.003；侧壁 e'速度 OR 0.10 [95%CI 0.01-0.70]，P=0.02）。当分别调整年龄、体重、原发性 PH 诊断、缺血时间和体外循环时间时，这些关联仍然存在。在这项试点研究中，术前 RV 收缩功能较差和 LV 舒张功能较差与 PGD3 相关，并且可能是小儿肺移植中可改变的受体危险因素。
