Bacich Daniela, Tessari Chiara, Ciccarelli Giulia, Lucertini Giovanni, Cerutti Alessia, Pradegan Nicola, Toscano Giuseppe, Di Salvo Giovanni, Gambino Antonio, Gerosa Gino
Cardiac Surgery Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy.
Pediatric Cardiology Unit, Department of Women's and Children's Health, University Hospital of Padova, 35128 Padova, Italy.
J Clin Med. 2024 May 29;13(11):3205. doi: 10.3390/jcm13113205.
Current guidelines for the care of heart transplantation recipients recommend routine endomyocardial biopsy and invasive coronary angiography as the cornerstones in the surveillance for acute rejection (AR) and coronary allograft vasculopathy (CAV). Non-invasive tools, including coronary computed tomography angiography and cardiac magnetic resonance, have been introduced into guidelines without roles of their own as gold standards. These techniques also carry the risk of contrast-related kidney injury. There is a need to explore non-invasive approaches providing valuable information while minimizing risks and allowing their application independently of patient comorbidities. Echocardiographic examination can be performed at bedside, serially repeated, and does not carry the burden of contrast-related kidney injury and procedure-related risk. It provides comprehensive assessment of cardiac morphology and function. Advanced echocardiography techniques, including Doppler tissue imaging and strain imaging, may be sensitive tools for the detection of minor myocardial dysfunction, thus providing insight into early detection of AR and CAV. Stress echocardiography may offer a valuable tool in the detection of CAV, while the assessment of coronary flow reserve can unravel coronary microvascular impairment and add prognostic value to conventional stress echocardiography. The review highlights the role of Doppler echocardiography in heart transplantation follow-up, weighting advantages and limitations of the different techniques.
目前心脏移植受者的护理指南推荐将常规心内膜心肌活检和有创冠状动脉造影作为监测急性排斥反应（AR）和冠状动脉移植血管病变（CAV）的基石。包括冠状动脉计算机断层扫描血管造影和心脏磁共振成像在内的非侵入性检查工具已被纳入指南，但并未作为金标准发挥自身作用。这些技术还存在与造影剂相关的肾损伤风险。有必要探索非侵入性方法，在将风险降至最低并允许独立于患者合并症应用的同时提供有价值的信息。超声心动图检查可在床边进行，可多次重复，且不存在与造影剂相关的肾损伤负担和与操作相关的风险。它能对心脏形态和功能进行全面评估。先进的超声心动图技术，包括多普勒组织成像和应变成像，可能是检测轻微心肌功能障碍的敏感工具，从而有助于早期发现AR和CAV。负荷超声心动图可能是检测CAV的有价值工具，而冠状动脉血流储备评估可揭示冠状动脉微血管损伤，并为传统负荷超声心动图增加预后价值。本综述强调了多普勒超声心动图在心脏移植随访中的作用，权衡了不同技术的优缺点。
