Orlandi Melissa, Corsi Marco, Bini Vittorio, Palazzo Roberto, Gitto Stefano, Fiorillo Claudia, Becatti Matteo, Maglione Marco, Stefani Laura
Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy.
Medicine Department, University of Perugia, 06100 Perugia, Italy.
J Pers Med. 2025 Jan 17;15(1):32. doi: 10.3390/jpm15010032.
: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. : 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). : The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS -0.406 ** and 2C PALS -0.276 *). : These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index.
实体器官移植受者（OTR）最近参与了运动处方项目，以降低心血管疾病的高患病率。正常的心脏收缩和舒张功能对于个性化处方至关重要。舒张功能障碍可能与心血管事件的较高风险相关，而左心房（LA）应变是评估舒张功能受损的一个新兴参数，特别是在射血分数保留的受试者中。左心房（LA）应变在这一类别中从未被探讨过。该研究旨在评估LA应变在评估OTR舒张功能中的作用及其在运动项目中的潜在贡献。：54名实体OTR（肝移植和肾移植）在基于家庭、部分监督的模式下进行了至少12个月的定期训练，运动强度为通过心肺运动试验估计的中等强度，接受了完整的超声心动图分析。测量的变量包括左心室收缩功能（射血分数，EF）、舒张功能（E/A和E/E'）、LA指数容积、LA心房纵向峰值应变（PALS）和LA心房收缩峰值应变（PACS）。将数据与44名健康受试者（HS）的数据进行比较。：OTR表现出超重情况（BMI：25.79±2.92 vs.22.25±2.95；<0.01）。两组均表现出保留的收缩功能（EF：OTR为63.1±3.5% vs.HS为66.9±6.1；<0.001），而舒张标准参数虽正常但有显著差异（E/A，OTR为1.01±0.4 vs.HS为1.96±0.74；<0.001；E/E'，OTR为9.2±2.7 vs.HS为6.9±1.3；<0.001）。与HS相比，OTR的LA应变显著降低（4C PALS，33.7±9.7 vs.45.4±14.19；<0.001；4C PACS，15.9±6.7 vs.11.6±7.5；=0.006；2C PALS，35.3±11.1 vs.47.6±14.9；<0.001；2C PALS，17.4±4.9 vs.13.2±14.97；=0.001，分别为OTR和HS）。观察到两腔和四腔PACS及PALS与BMI之间存在特定相关性（4C PALS的R为-0.406**，2C PALS的R为-0.276*）。：这些发现表明，无症状OTR患者体重增加的同时存在会加剧LA应变的损害。LA应变检测可能有助于为OTR制定个性化运动项目，特别是对于无症状受试者和心血管风险较高的受试者，以潜在地长期管理运动项目。更大规模的研究将通过最终的结构化临床评分指数来确认其作用。
