Dodd D A, Brady L D, Carden K A, Frist W H, Boucek M M, Boucek R J
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn.
J Heart Lung Transplant. 1993 Nov-Dec;12(6 Pt 1):1009-17.
In patients who have undergone successful orthotopic heart transplantation, a noninvasive method for rejection surveillance would reduce the frequency of endomyocardial biopsy, guide the timing of biopsies, and allow for more frequent monitoring. This study identified the pattern of change in echocardiographically determined indexes of left ventricular mass, volume, and function that characterized biopsy-positive acute rejection in adult heart transplant patients receiving triple-drug immunosuppressive therapy and describes a simple computer-driven algorithm capable of identifying rejection with high sensitivity and specificity. Two-dimensional and M-mode echocardiography and Doppler color flow analyses were performed within 24 hours of endomyocardial biopsy. M-mode echocardiograms of the left ventricle were digitized and analyzed blinded to the biopsy interpretation, using a computer-assisted measurement format, for size, mass, and wall motion in systole and diastole. Twenty-nine studies were retrospectively analyzed to define the echocardiographic pattern characteristic for rejection. Left ventricular chamber size decreased, and indexes of diastolic function were significantly depressed in patients with biopsy evidence of moderate or severe rejection. However, no single parameter was sufficiently sensitive to detect all episodes of rejection partly because of differences between patients in the echocardiographic manifestations of acute rejection. To accommodate this patient variability, multiple echocardiographic parameters were clustered into a unique scoring algorithm (ECHO score). When applied prospectively to 49 studies, the likelihood that a patient would have an ECHO score not indicative of rejection but with moderate/severe rejection on biopsy was low (less than 3%) or a negative predictive value of 97.4%.(ABSTRACT TRUNCATED AT 250 WORDS)
在接受原位心脏移植手术成功的患者中，一种用于排斥反应监测的非侵入性方法将减少心内膜活检的频率，指导活检时机，并实现更频繁的监测。本研究确定了在接受三联药物免疫抑制治疗的成年心脏移植患者中，经超声心动图测定的左心室质量、容积和功能指标的变化模式，这些变化模式表征了活检阳性的急性排斥反应，并描述了一种简单的计算机驱动算法，该算法能够以高灵敏度和特异性识别排斥反应。在心内膜活检后24小时内进行二维和M型超声心动图以及多普勒彩色血流分析。使用计算机辅助测量格式，将左心室的M型超声心动图数字化，并在对活检结果不知情的情况下进行分析，以测量收缩期和舒张期的大小、质量和壁运动。对29项研究进行回顾性分析，以确定排斥反应的超声心动图特征模式。在有中度或重度排斥反应活检证据的患者中，左心室腔大小减小，舒张功能指标显著降低。然而，没有一个单一参数对检测所有排斥反应发作都足够敏感，部分原因是急性排斥反应的超声心动图表现因患者而异。为了适应这种患者差异，将多个超声心动图参数聚类成一种独特的评分算法（ECHO评分）。当前瞻性应用于49项研究时，患者ECHO评分不提示排斥反应但活检显示中度/重度排斥反应的可能性很低（低于3%），即阴性预测值为97.4%。（摘要截断于250字）
