Schäfer Michal, Miyamoto Shelley D, Jaggers James, Everitt Melanie D, von Alvensleben Johannes C, Campbell David N, Mitchell Max B, Stone Matthew L
Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
Heart Institute, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045-2560, USA.
Int J Cardiovasc Imaging. 2024 Jul;40(7):1565-1574. doi: 10.1007/s10554-024-03143-6. Epub 2024 May 23.
There is an urgent need for non-invasive imaging-based biomarkers suitable for diagnostic surveillance of cardiac allograft vasculopathy (CAV) in pediatric heart transplant (PHT) patients. The purpose of this study was to comprehensively investigate left ventricular (LV) myocardial deformation in conjunction with electromechanical discoordination in PHT. PHT patients with and without CAV were evaluated for echocardiography derived global longitudinal strain (GLS) and electromechanical discoordination indices including systolic stretch fraction (SSF) and diastolic relaxation fraction (DRF). SSF was increased in CAV(+) patients at the time of CAV diagnosis (median CAV(+) 5.0 vs. median CAV(-) 0.0, P = 0.008) and in the echocardiogram preceding the CAV diagnosis (median CAV(+) 29.0 vs. median CAV(-) 0.0, P < 0.001). DRF was also increased in the echocardiogram that preceded CAV diagnosis in CAV(+) patients (0.31 ± 0.08 vs. 0.25 ± 0.05, P = 0.008). The final model using indices 6-12 months prior to CAV diagnosis included GLS, SSF, and DRF providing AUC of 0.94 with sensitivity 98.5%, specificity 80.0%, positive predictive value 85.0%, and negative predictive value 94.1%. Systolic and diastolic electro-mechanical discoordination indices are significantly worse in PHT patients experiencing CAV. Non-invasive imaging guided surveillance using echocardiographic myocardial deformation indices can be improved by adding SSF and DRF to standard GLS measurements.
迫切需要适用于小儿心脏移植（PHT）患者心脏移植血管病变（CAV）诊断监测的非侵入性成像生物标志物。本研究的目的是全面研究PHT患者左心室（LV）心肌变形与机电失调情况。对有和没有CAV的PHT患者进行超声心动图评估，得出整体纵向应变（GLS）以及包括收缩期伸展分数（SSF）和舒张期松弛分数（DRF）在内的机电失调指标。在CAV诊断时，CAV（+）患者的SSF升高（CAV（+）中位数为5.0，而CAV（-）中位数为0.0，P = 0.008），并且在CAV诊断前的超声心动图中也升高（CAV（+）中位数为29.0，而CAV（-）中位数为0.0，P <0.001）。在CAV（+）患者CAV诊断前的超声心动图中，DRF也升高（0.31±0.08对0.25±0.05，P = 0.008）。使用CAV诊断前6至12个月的指标建立的最终模型包括GLS、SSF和DRF，曲线下面积（AUC）为0.94，敏感性为98.5%，特异性为80.0%，阳性预测值为85.0%，阴性预测值为94.1%。发生CAV的PHT患者的收缩期和舒张期机电失调指标明显更差。通过在标准GLS测量中加入SSF和DRF，可以改善使用超声心动图心肌变形指标进行的非侵入性成像引导监测。
