Kerkhof Peter L M, Heyndrickx Guy R
Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, Netherlands.
Department of Cardiology, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
Eur Heart J Case Rep. 2021 May 29;5(6):ytab146. doi: 10.1093/ehjcr/ytab146. eCollection 2021 Jun.
Sequential determinations of left ventricular (LV) volume constitute a cornerstone in the mechanical performance evaluation of any heart transplant (HTX) patient. A comprehensive analysis of volumetric data offers unique insight into adaptation and pathophysiology.
With a focus on eight sequential biplane angiocardiographic LV end-systolic volume (ESV) determinations, we evaluate the clinical course of a male patient following HTX (female donor) at the age of 61 years. This former smoker had a history of chronic obstructive pulmonary disease, hypertension, and hypercholesterolaemia refractory to treatment, and presented with multivessel coronary artery disease. The later course was complicated by pulmonary hypertension, an abdominal aortic aneurysm, and secondary chronic kidney disease. After an additional episode of pulmonary embolism, the patient died at the age of 79. At one point, the ESV was > 700% higher than the starting value, and actually by far exceeded the relative change of any other volume-based metric evaluated, including ejection fraction (EF).
The longitudinal study of LV volumetric data in HTX patients offers a unique window to the pathophysiology of remodelling and sex-specific adaptation processes. The present case documents that proper analysis of serial findings form a rich source of clinically relevant information regarding disease progression. End-systolic volume is the primary indicator, in contrast to the popular metric EF. This finding is supported by population-based studies reported in the literature. We conclude that comprehensive analysis of volumetric data, particularly ESV, contributes to personalized medicine and enhances insight into LV (reverse) remodelling, while also informing about prognosis.
连续测定左心室（LV）容积是评估任何心脏移植（HTX）患者机械性能的基石。对容积数据进行全面分析可为适应过程和病理生理学提供独特见解。
我们重点关注八次连续的双平面血管造影左心室收缩末期容积（ESV）测定，评估了一名61岁男性HTX患者（女性供体）的临床病程。这位曾经吸烟的患者有慢性阻塞性肺疾病、高血压和难治性高胆固醇血症病史，并患有多支冠状动脉疾病。后期病程并发肺动脉高压、腹主动脉瘤和继发性慢性肾病。在又一次发生肺栓塞后，患者于79岁去世。有一次，ESV比起始值高出700%以上，实际上远远超过了所评估的任何其他基于容积的指标的相对变化，包括射血分数（EF）。
对HTX患者左心室容积数据进行纵向研究为重塑的病理生理学和性别特异性适应过程提供了一个独特的窗口。本病例证明，对系列检查结果进行恰当分析可成为有关疾病进展的丰富临床相关信息来源。与常用指标EF不同，收缩末期容积是主要指标。这一发现得到了文献中基于人群的研究的支持。我们得出结论，对容积数据，尤其是ESV进行全面分析有助于个性化医疗，并增强对左心室（逆向）重塑的认识，同时也能为预后提供信息。
