Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients

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• 作者：Tomoko-Sugiyama Kato ; Noboru Oda ; Kazuhiko Hashimura ; Shuji Hashimoto ; Takeshi Nakatani ; Hatsue-Ishibashi Ueda ; Toshiaki Shishido ; Kazuo Komamura
• 关键词：Heart transplant ; Rejection ; Echocardiography ; Diagnosis
• 刊名：European Journal of Cardio-Thoracic Surgery
• 出版年：2010
• 出版时间：May 2010
• 年：2010
• 卷：37
• 期：5
• 页码：1104-1110
• 全文大小：215 K

文摘

Objective: Non-invasive diagnosis of rejection is a major objective in the management of heart transplant recipients. The ability of strain rate (SR) imaging on echocardiograms to detect rejection in heart transplant recipients was investigated. Methods: A total of 396 endomyocardial biopsies, right-heart catheterisation and echocardiograms were performed in 35 heart transplant recipients. Mean values of systolic strain (_sys), peak systolic SR (SR_sys), and peak early diastolic SR (SR_dia) obtained from eight left ventricular segments were calculated. Results: According to the conventional International Society for Heart and Lung Transplantation criteria, 351 biopsies showed a rejection grade (acute rejection, AR) of 0 or 1a (group AR⁻) whereas 45 biopsies showed a grade of 1b or higher (group AR⁺). The _sys, SR_sys and SR_dia were significantly different between group AR⁺ and group AR⁻ (−20.7 ± 8.0 vs −32.6 ± 6.3 % , p < 0.0001, 2.5 ± 1.8 vs 3.6 ± 1.1/s, p < 0.0001, and −1.9 ± 1.6 vs −3.5 ± 1.3/s, p < 0.001, respectively). Multivariate analysis identified _sys (p < 0.0001) as a strong predictor for group AR⁺, and _sys cut-off value of −27.4 % was associated with a predictive accuracy of 82.3 % . The combination of _sys and SR_dia discriminated group AR⁺ from group AR⁻ with a predictive accuracy of 84.8 % . The pulmonary artery wedge pressure was higher in group AR⁺ than that in group AR⁻ (7.4 ± 3.0 vs 9.4 ± 4.4 mmHg, p < 0.05). Conclusion: SR imaging is of potential clinical value for monitoring acute rejection in heart transplant recipients.