Ross H J, Gullestad L, Hunt S A, Tovey D A, Puryear J B, McMillan A, Stinson E B, Valantine H A
Division of Cardiovascular Medicine, Stanford University School of Medicine, Calif 94305-5246, USA.
Circulation. 1996 Nov 1;94(9 Suppl):II289-93.
Doppler echocardiographic (DE) diastolic dysfunction has been correlated with rejection after orthotopic cardiac transplantation (Tx). However, the relationship of early diastolic dysfunction to late outcome is unknown. The purpose of this study was to assess the correlation between early DE diastolic dysfunction and outcome after heart Tx.
Of 133 patients undergoing heart Tx between October 1990 and April 1994, 83 were identified with > or = 4 routine DE performed during the first 6 months. Assessment of diastolic function included measurement of isovolumic relaxation time (IVRT), pressure half-time (PHT), and peak early mitral inflow velocity (M1). Diastolic dysfunction was defined as a decrease of 15% from baseline (IVRT and PHT) or an increase of 20% (M1). A mean dysfunction score (MDS) was calculated for each patient (number of episodes of dysfunction by Doppler total number of echocardiograms performed). The population diastole MDS was determined and two groups established (group 1, MDS < mean; group 2, MDS > mean). Actuarial survival, rejection, and transplant coronary artery disease (TxCAD) were compared between groups. Actuarial survival was significantly reduced in patients with greater early diastolic dysfunction (P < .05). There were 17 deaths overall: 5 in group 1 (mean, 786 days) and 12 in group 2 (mean, 384 days). There were no significant differences in treated rejection episodes, actuarial freedom from rejection or TxCAD, immunosuppression, sex, donor age, donor ischemic time, or cytomegalovirus between the two groups.
Diastolic dysfunction within 6 months of transplant was associated with an increased late mortality.
多普勒超声心动图（DE）检测的舒张功能障碍与原位心脏移植（Tx）后的排斥反应相关。然而，早期舒张功能障碍与晚期预后的关系尚不清楚。本研究的目的是评估心脏移植术后早期DE舒张功能障碍与预后之间的相关性。
在1990年10月至1994年4月期间接受心脏移植的133例患者中，83例在术后前6个月内进行了≥4次常规DE检查。舒张功能评估包括等容舒张时间（IVRT）、压力减半时间（PHT）和二尖瓣早期血流峰值速度（M1）的测量。舒张功能障碍定义为较基线水平下降15%（IVRT和PHT）或升高20%（M1）。计算每位患者的平均功能障碍评分（MDS）（功能障碍发作次数/多普勒超声心动图检查总数）。确定总体舒张MDS并分为两组（第1组，MDS<平均值；第2组，MDS>平均值）。比较两组的精算生存率、排斥反应和移植冠状动脉疾病（TxCAD）。早期舒张功能障碍较重的患者精算生存率显著降低（P<.05）。总共有17例死亡：第1组5例（平均786天），第2组12例（平均384天）。两组在治疗的排斥反应发作次数、无排斥反应或TxCAD的精算自由度、免疫抑制、性别、供体年龄、供体缺血时间或巨细胞病毒方面无显著差异。
移植后6个月内的舒张功能障碍与晚期死亡率增加相关。
