Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr. Enéas Carvalho de Aguiar, 44, São Paulo, Cerqueira CesarSP, 05403-900, Brazil.
Division of Pediatric Surgery and Liver Transplantation Unit, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
Sci Rep. 2021 Sep 8;11(1):17807. doi: 10.1038/s41598-021-97096-8.
To evaluate the ventricular function of patients with biliary atresia (BA) before and after liver transplantation using two-dimensional speckle tracking. Observational, analytical study with healthy control group, volunteers. We recruited patients from 0 to 18 years old who were candidates for liver transplantation and patients after six months of liver transplantation performed for BA from January 1997 to August 2015 at Children's Institute of São Paulo University Medical School. The patients were submitted to a complete conventional echocardiographic study. After that, the images were captured for global longitudinal strain (GLS). A blood sample was collected for brain natriuretic peptide (BNP) level. Ejection fraction obtained by Simpson's method was significantly higher in the hepatic pre-transplantation group (p < 0.001), as well as left atrial size (p < 0.001) and left ventricle size (p = 0.039). The left ventricular mass index was significantly higher in pre-transplantation group (p < 0.001). The left atrium volume (p = 0.008) and the left ventricular mass index (p t = 0.035) were higher in the post-transplant group. It was observed that the lower the BNP, the lower/more negative the GLS in the post-transplant group (p = 0.038 and r = 0.427). Significant reduction in the overall longitudinal strain of the left ventricle was detected before (p = 0.01) and after liver transplantation (p = 0.019). A subclinical left ventricular systolic dysfunction was evidenced by two-dimensional speckle tracking technique before and after liver transplantation, even when compared to normal values of the last pediatric meta-analysis.
采用二维斑点追踪技术评价胆道闭锁(BA)患者肝移植前后的心室功能。观察性、分析性研究,设有健康对照组和志愿者组。我们招募了 1997 年 1 月至 2015 年 8 月期间因 BA 接受肝移植且年龄在 0 至 18 岁之间的患者以及肝移植 6 个月后的患者作为研究对象,这些患者均在圣保罗大学医学院儿童研究所接受了完整的常规超声心动图研究。此后,我们对所有患者的图像进行了全局纵向应变(GLS)的采集。采集血样以检测脑钠肽(BNP)水平。辛普森法获得的射血分数在肝移植前组显著更高(p<0.001),左心房大小(p<0.001)和左心室大小(p=0.039)也是如此。左心室质量指数在肝移植前组显著更高(p<0.001)。在肝移植后组,左心房容积(p=0.008)和左心室质量指数(p t=0.035)更高。我们观察到,移植后组的 BNP 越低,GLS 越低/越负(p=0.038 和 r=0.427)。肝移植前后均发现左心室整体纵向应变显著降低(p=0.01 和 p=0.019)。二维斑点追踪技术证实,即使与最近一次儿科荟萃分析的正常数值相比,BA 患者在肝移植前后均存在亚临床左心室收缩功能障碍。