Mouly-Bandini A, Vion-Dury J, Viout P, Mesana T, Cozzone P J, Montiès J R
Service de Chirurgie Cardiaque, Centre Hospitalo-Universitaire de la Timone, Marseille, France.
Transpl Int. 1996;9(2):131-6. doi: 10.1007/BF00336390.
Modifications of the diastolic parameters pressure half-time (PHT) and isovolumic relaxation time (IVRT), recorded using cardiac Doppler echocardiography (CDE), were studied in 23 heart transplant recipients and compared to the results of 345 endomyocardial biopsies (EMB) performed on the same day. Two different protocols, analyzing respectively (1) a decrease of 20% or more in IVRT and/or PHT with respect to the mean and (2) a decrease of 20% or more in IVRT and/ or PHT with respect to its preceding value, were used to evaluate the efficiency of CDE in diagnosing mild and moderate rejections. When a mild rejection was detected by EMB, a statistically significant decrease was found in the average CDE parameter values of the patient population. However, these variations were weak and did not differ from the spontaneous variations observed in each patient in the absence of rejection. Thus, it is not surprising that the sensitivity of CDE in the detection of mild rejections was very low (45%) using the most sensitive protocol (variations of the parameters from their preceding value). We conclude that CDE alone does not seem to be sufficient to perform the noninvasive diagnosis of low-grade rejections and must be complemented by other noninvasive methods.
采用心脏多普勒超声心动图（CDE）记录舒张参数压力半衰期（PHT）和等容舒张时间（IVRT）的变化情况，对23例心脏移植受者进行了研究，并与同日进行的345次心内膜心肌活检（EMB）结果进行比较。采用两种不同方案分别分析：（1）IVRT和/或PHT相对于平均值下降20%或更多；（2）IVRT和/或PHT相对于其先前值下降20%或更多，以评估CDE诊断轻度和中度排斥反应的效率。当EMB检测到轻度排斥反应时，患者群体的平均CDE参数值出现了统计学上的显著下降。然而，这些变化很微弱，与未发生排斥反应时各患者观察到的自发变化并无差异。因此，使用最敏感方案（参数相对于其先前值的变化）时，CDE检测轻度排斥反应的敏感性非常低（45%）也就不足为奇了。我们得出结论，仅靠CDE似乎不足以进行低级别排斥反应的无创诊断，必须辅以其他无创方法。
