Usuku Hiroki, Yamamoto Eiichiro, Nishi Masato, Komorita Takashi, Takae Masafumi, Nishihara Taiki, Oike Fumi, Ishii Masanobu, Fujisue Koichiro, Sueta Daisuke, Araki Satoshi, Takashio Seiji, Oda Seitaro, Misumi Yohei, Ueda Mitsuharu, Nakamura Taishi, Kawano Hiroaki, Soejima Hirofumi, Sakamoto Kenji, Kaikita Koichi, Ando Yukio, Matsui Hirotaka, Tsujita Kenichi
Department of Laboratory Medicine, Kumamoto University Hospital Kumamoto Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan.
Circ Rep. 2020 Nov 10;2(12):730-738. doi: 10.1253/circrep.CR-20-0106.
Using transthoracic echocardiography, including 2D speckle tracking imaging (STI), this study examined cardiac function after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary amyloidogenic transthyretin amyloidosis. In all, 14 patients who underwent DLT at Kumamoto University Hospital and for whom 2D STI information was available were enrolled in the study; time-dependent echocardiographic changes were evaluated in 7. Although left ventricular (LV) systolic and diastolic function did not differ between the pre- and post-DLT periods (mean [±SD] 5.4±1.0 years after DLT), there were significant (P<0.05 for all) increases in the post- vs. pre-DLT period in basal longitudinal strain (LS; -13.4±2.3 vs. -19.3±4.4), relative apical LS index (=apical LS/[basal LS+mid LS]; 0.75±0.20 vs. 0.58±0.08), and LV ejection fraction/global LS (3.91±0.58 vs. 3.06±0.44). Age at the time of DLT was significantly higher in the group with impaired (>-14%) than preserved basal LS (57.2±3.5 vs. 39.6±16.0 years; P<0.05). When control subjects (n=14) were added to the enrolled DLT recipients, multivariable logistic regression analysis revealed that a history of DLT was significantly associated with impaired basal LS (>-14%; odds ratio 28.39, 95% confidence interval 1.89-427.45, P<0.05). LV systolic and diastolic function was preserved in the long term after DLT. However, 2D STI revealed subtle cardiac dysfunction in DLT recipients, which may be an early manifestation of cardiac amyloidosis.
本研究采用经胸超声心动图，包括二维斑点追踪成像（STI），对遗传性转甲状腺素蛋白淀粉样变性患者肝移植的多米诺肝移植（DLT）术后心脏功能进行了检查。共有14例在熊本大学医院接受DLT且有二维STI信息的患者纳入本研究；对其中7例患者评估了随时间变化的超声心动图改变。尽管DLT前后左心室（LV）的收缩和舒张功能无差异（DLT后平均[±标准差]5.4±1.0年），但与DLT前相比，DLT后基底纵向应变（LS；-13.4±2.3对-19.3±4.4）、相对心尖LS指数（=心尖LS/[基底LS + 中间LS]；0.75±0.20对0.58±0.08）以及LV射血分数/整体LS（3.91±0.58对3.06±0.44）均有显著增加（所有P<0.05）。DLT时，基底LS受损（>-14%）组的年龄显著高于基底LS保留组（57.2±3.5对39.6±16.0岁；P<0.05）。当将对照组（n = 14）加入已纳入的DLT受者中时，多变量逻辑回归分析显示，DLT病史与基底LS受损（>-14%）显著相关（比值比28.39，95%置信区间1.89 - 427.45，P<0.05）。DLT后长期保留了LV的收缩和舒张功能。然而，二维STI显示DLT受者存在细微的心脏功能障碍，这可能是心脏淀粉样变性的早期表现。
