Iwańczyk Sylwia, Woźniak Patrycja, Smukowska-Gorynia Anna, Araszkiewicz Aleksander, Nowak Alicja, Jankowski Maurycy, Konwerska Aneta, Urbanowicz Tomasz, Lesiak Maciej
1st Department of Cardiology, Poznan University of Medical Sciences, 60-701 Poznań, Poland.
Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-701 Poznań, Poland.
J Clin Med. 2023 Jun 4;12(11):3838. doi: 10.3390/jcm12113838.
Although the treatment and prognosis of patients after heart transplantation have significantly improved, late graft dysfunction remains a critical problem. Two main subtypes of late graft dysfunction are currently described: acute allograft rejection and cardiac allograft vasculopathy, and microvascular dysfunction appears to be the first stage of both. Studies revealed that coronary microcirculation dysfunction, assessed by invasive methods in the early post-transplant period, correlates with a higher risk of late graft dysfunction and death during long-term follow-up. The index of microcirculatory resistance, measured early after heart transplantation, might identify the patients at higher risk of acute cellular rejection and major adverse cardiovascular events. It may also allow optimization and enhancement of post-transplantation management. Moreover, cardiac allograft vasculopathy is an independent prognostic factor for transplant rejection and survival rate. The studies showed that the index of microcirculatory resistance correlates with anatomic changes and reflects the deteriorating physiology of the epicardial arteries. In conclusion, invasive assessment of the coronary microcirculation, including the measurement of the microcirculatory resistance index, is a promising approach to predict graft dysfunction, especially the acute allograft rejection subtype, during the first year after heart transplantation. However, further advanced studies are needed to fully grasp the importance of microcirculatory dysfunction in patients after heart transplantation.
尽管心脏移植术后患者的治疗和预后有了显著改善,但晚期移植物功能障碍仍然是一个关键问题。目前描述的晚期移植物功能障碍主要有两种亚型:急性同种异体移植排斥反应和心脏同种异体移植血管病变,而微血管功能障碍似乎是两者的第一阶段。研究表明,在移植后早期通过侵入性方法评估的冠状动脉微循环功能障碍与长期随访期间晚期移植物功能障碍和死亡的较高风险相关。心脏移植术后早期测量的微循环阻力指数可能会识别出急性细胞排斥反应和主要不良心血管事件风险较高的患者。它还可能有助于优化和加强移植后管理。此外,心脏同种异体移植血管病变是移植排斥反应和生存率的独立预后因素。研究表明,微循环阻力指数与解剖学变化相关,并反映了心外膜动脉生理功能的恶化。总之,冠状动脉微循环的侵入性评估,包括微循环阻力指数的测量,是预测心脏移植术后第一年移植物功能障碍,尤其是急性同种异体移植排斥反应亚型的一种有前景的方法。然而,需要进一步的深入研究来充分理解心脏移植术后患者微循环功能障碍的重要性。