Obremska Marta, Przybylski Roman, Sokolski Mateusz, Przewłocka-Kosmala Monika, Rakowski Mateusz, Ptak Jakub, Sareło Przemysław, Zakliczyński Michał, Kosmala Wojciech
Institute of Heart Diseases, Wrocław Medical University, 50-556 Wrocław, Poland.
Institute of Heart Diseases, University Clinical Hospital, 50-556 Wrocław, Poland.
J Clin Med. 2024 Dec 15;13(24):7643. doi: 10.3390/jcm13247643.
: Currently, the most popular techniques for orthotopic heart transplantation (OHTx) are bicaval and total OHTx. Although bicaval OHTx has shown advantages over the biatrial approach, comparisons between bicaval and total OHTx reain limited. To compare the functional and morphological characteristics of the left atrium (LA) in patients after bicaval and total OHTx. : Sixty-six patients (age 51.2 ± 10.5 years) after total OHTx (33 patients) and bicaval OHTx (33 patients) were included in this case-control study. Recipients were matched for sex, age, and time from transplantation and absence of severe graft rejection based on routine endomyocardial biopsies (EMB) performed during follow-up. Echocardiography included standard measurements along with a speckle-tracking assessment of LA strain. : Compared with the bicaval OHTx, the total OHTx group showed higher atrial mitral inflow velocity, resulting in a lower E/A ratio, lower LA volume index, and higher LA emptying fraction. Both the reservoir and contraction components of LA function, as assessed by LA deformation, were found to show more favorable profiles in the total OHTx group than in the bicaval group (26.5 ± 6.9 vs. 17.4 ± 4.7, < 0.001 and 14.8 ± 5.8 vs. 6.0 ± 4.5, < 0.001, respectively). Multivariable analysis identified surgical technique, left ventricular global longitudinal strain, and the presence of diabetes in the recipient as independent determinants of LA strain. : Total OHTx is associated with better LA morphology and function than bicaval OHTx. This may provide better conditions for LA-LV coupling in transplanted hearts and contribute to a more stable electrophysiological environment in atrial tissue.
目前，原位心脏移植（OHTx）最常用的技术是双腔静脉和全OHTx。尽管双腔静脉OHTx已显示出优于双心房方法的优势，但双腔静脉和全OHTx之间的比较仍然有限。为了比较双腔静脉和全OHTx术后患者左心房（LA）的功能和形态特征。：本病例对照研究纳入了66例全OHTx（33例患者）和双腔静脉OHTx（33例患者）术后的患者（年龄51.2±10.5岁）。根据随访期间进行的常规心内膜心肌活检（EMB），受体在性别、年龄、移植时间和无严重移植物排斥方面进行匹配。超声心动图包括标准测量以及LA应变的斑点追踪评估。：与双腔静脉OHTx相比，全OHTx组显示出更高的心房二尖瓣流入速度，导致更低的E/A比值、更低的LA容积指数和更高的LA排空分数。通过LA变形评估的LA功能的储存和收缩成分在全OHTx组中均显示出比双腔静脉组更有利的特征（分别为26.5±6.9对17.4±4.7，<0.001和14.8±5.8对6.0±4.5，<0.001）。多变量分析确定手术技术、左心室整体纵向应变和受体中糖尿病的存在是LA应变的独立决定因素。：与双腔静脉OHTx相比，全OHTx与更好的LA形态和功能相关。这可能为移植心脏中的LA-LV耦合提供更好的条件，并有助于心房组织中更稳定的电生理环境。
