Murphy J D, Mergo P J, Taylor H M, Fields R, Mills R M
Department of Medicine and Diagnostic Radiology, University of Florida, Gainesville 32610-0374, USA.
AJR Am J Roentgenol. 1998 Aug;171(2):371-4. doi: 10.2214/ajr.171.2.9694454.
The purpose of this study is to evaluate the clinical significance of radiographic cardiomegaly in orthotopic heart transplant recipients and to identify causative anatomic and physiologic parameters.
We retrospectively compared the cardiothoracic ratio (CTR) measured using standard posteroanterior chest radiography with left ventricular end-diastolic diameter and left ventricular ejection fraction measured on two-dimensional echocardiography; right ventricular systolic pressure; and systolic, diastolic, and mean blood pressure measured at biopsy in 46 heart transplant recipients.
Twenty-eight (61%) of the 46 patients had radiographic cardiomegaly. When we compared heart transplant recipients who had a CTR greater than 0.5 with recipients who had a CTR less than or equal to 0.5, we found no significant difference between their respective left ventricular end-diastolic diameters, left ventricular ejection fractions, right ventricular systolic pressures, systolic blood pressures, or mean blood pressures. A statistically significant difference existed between the mean values of diastolic blood pressure for transplant recipients with and without radiographic cardiomegaly. We found no significant correlation between CTR and left ventricular end-diastolic diameter, left ventricular ejection fraction, systolic blood pressure, diastolic blood pressure, or mean blood pressure.
The statistically significant difference between the mean values of diastolic blood pressure of transplant recipients with and without radiographic cardiomegaly is clinically insignificant and unlikely to account for the finding of radiographic cardiomegaly. We conclude that radiographic cardiomegaly, which occurs frequently in heart transplant recipients, does not correlate with anatomic or physiologic parameters obtained under the same conditions. Radiographic cardiomegaly in heart transplant recipients does not connote allograft dysfunction or heart failure.
本研究旨在评估原位心脏移植受者中X线胸片显示心脏增大的临床意义，并确定相关的解剖学和生理学参数。
我们回顾性比较了46例心脏移植受者经标准后前位胸片测量的心胸比（CTR）与经二维超声心动图测量的左心室舒张末期内径、左心室射血分数；右心室收缩压；以及活检时测量的收缩压、舒张压和平均血压。
46例患者中有28例（61%）X线胸片显示心脏增大。当我们将CTR大于0.5的心脏移植受者与CTR小于或等于0.5的受者进行比较时，发现他们各自的左心室舒张末期内径、左心室射血分数、右心室收缩压、收缩压或平均血压之间没有显著差异。有和没有X线胸片显示心脏增大的移植受者舒张压平均值之间存在统计学显著差异。我们发现CTR与左心室舒张末期内径、左心室射血分数、收缩压、舒张压或平均血压之间没有显著相关性。
有和没有X线胸片显示心脏增大的移植受者舒张压平均值之间的统计学显著差异在临床上无显著意义，不太可能解释X线胸片显示心脏增大这一发现。我们得出结论，心脏移植受者中经常出现的X线胸片显示心脏增大与在相同条件下获得的解剖学或生理学参数无关。心脏移植受者的X线胸片显示心脏增大并不意味着同种异体移植功能障碍或心力衰竭。
