Verhoeven P P, Lee F A, Ramahi T M, Franco K L, Mendes de Leon C, Amatruda J, Gorham N A, Mattera J A, Wackers F J
Department of Internal Medicine (Section of Cardiovascular Medicine), Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA.
J Am Coll Cardiol. 1996 Jul;28(1):183-9. doi: 10.1016/0735-1097(96)00094-0.
We sought to evaluate the prognostic value of routine noninvasive testing--stress thallium-201 imaging, rest two-dimensional echocardiography and rest equilibrium radionuclide angiography--1 year after cardiac transplantation.
Coronary artery vasculopathy is the most important cause of late death after orthotopic cardiac transplantation. Several clinical variables have been identified as risk factors for development of coronary vasculopathy. Traditional noninvasive diagnostic testing has been shown to be relatively insensitive for identifying patients with angiographic vasculopathy.
Results of prospectively acquired noninvasive testing in 47 consecutive transplant recipients alive 1 year after transplantation were related to subsequent survival. Other clinical variables previously shown to be associated with the development of coronary artery vasculopathy were also included in the analysis.
The 5-year survival rate after cardiac transplantation was 81%. By univariate analysis, echocardiography (chi-square 9.21) and stress thallium-201 myocardial perfusion imaging (chi-square 16.76) were predictive for survival, whereas rest equilibrium radionuclide angiography was not. Clinical contributors to survival were donor age (chi-square 4.56), number of human leukocyte antigen mismatches (chi-square 3.06) and cold ischemic time (chi-square 3.23). By multivariate analysis, stress myocardial imaging remained the only significant predictor of survival (risk ratio 0.27; 95% confidence interval 0.06 to 0.89).
Normal thallium-201 stress myocardial perfusion imaging 1 year after cardiac transplantation is an important predictor of 5-year survival.
我们试图评估心脏移植术后1年常规非侵入性检查——运动铊-201心肌显像、静息二维超声心动图和静息平衡放射性核素血管造影——的预后价值。
冠状动脉血管病变是原位心脏移植术后晚期死亡的最重要原因。几个临床变量已被确定为冠状动脉血管病变发生的危险因素。传统的非侵入性诊断检查已被证明在识别血管造影显示有血管病变的患者方面相对不敏感。
对47例移植后存活1年的连续移植受者进行前瞻性非侵入性检查的结果与随后的生存率相关。分析中还纳入了先前显示与冠状动脉血管病变发生相关的其他临床变量。
心脏移植后的5年生存率为81%。单因素分析显示，超声心动图（卡方值9.21）和运动铊-201心肌灌注显像（卡方值16.76）可预测生存率，而静息平衡放射性核素血管造影则不能。影响生存的临床因素包括供体年龄（卡方值4.56）、人类白细胞抗原错配数（卡方值3.06）和冷缺血时间（卡方值3.23）。多因素分析显示，运动心肌显像仍然是生存的唯一重要预测因素（风险比0.27；95%置信区间0.06至0.89）。
心脏移植术后1年铊-201运动心肌灌注显像正常是5年生存率的重要预测指标。
