Prasad Pooja, Nagappan Raj, Davidson Brian P, Wei Kevin, Hodovan James, Lindner Jonathan R, Steiner Johannes
Oregon Health & Science University, Portland, OR, USA.
University of Virginia Health System, Charlottesville, VA, USA.
ESC Heart Fail. 2023 Oct;10(5):3184-3189. doi: 10.1002/ehf2.14464. Epub 2023 Jul 4.
Cardiac allograft vasculopathy (CAV) remains a common long-term complication of cardiac transplantation. While invasive coronary angiography is considered the gold standard, it is also invasive and lacks sensitivity to detect early, distal CAV. Although vasodilator stress myocardial contrast echocardiography perfusion imaging (MCE) is used in the detection of microvascular disease in non-transplant patients, there is little data guiding its use in transplant recipients. Herein is a case series of four heart transplant recipients that had vasodilator stress MCE performed in addition to invasive coronary angiography for CAV surveillance. MCE at rest and after regadenason was performed using a continuous infusion of lipid-shelled microbubbles. We describe a case of normal microvascular function, diffuse microvascular dysfunction, patchy sub-endocardial perfusion defects and a focal sub-endocardial perfusion defect. Cardiac allograft vasculopathy can be heralded by several different perfusion patterns on MCE in patients after orthotopic heart transplant. The varying prognoses and potential interventions for these different patterns require further investigation.
心脏移植血管病变（CAV）仍然是心脏移植常见的长期并发症。虽然有创冠状动脉造影被认为是金标准，但它具有侵入性，且对早期远端CAV缺乏敏感性。尽管血管扩张剂负荷心肌对比超声心动图灌注成像（MCE）用于检测非移植患者的微血管疾病，但在指导其在移植受者中的应用方面几乎没有数据。本文是一个病例系列，包含四名心脏移植受者，他们除了接受有创冠状动脉造影进行CAV监测外，还进行了血管扩张剂负荷MCE。使用连续输注脂质包裹的微泡进行静息和瑞加德松负荷后的MCE。我们描述了一个微血管功能正常、弥漫性微血管功能障碍、斑片状心内膜下灌注缺损和局灶性心内膜下灌注缺损的病例。原位心脏移植术后患者的MCE上有几种不同的灌注模式可预示心脏移植血管病变。这些不同模式的不同预后和潜在干预措施需要进一步研究。
