Cecilia Beatriz Bittencourt Viana Cruz, Ludhmila A Hajjar, Fernando Bacal, Marco S Lofrano-Alves, Márcio S M Lima, Maria C Abduch, Marcelo L C Vieira, Hsu P Chiang, Juliana B C Salviano, Isabela Bispo Santos da Silva Costa, Julia Tizue Fukushima, Joao C N Sbano, Wilson Mathias, Jeane M Tsutsui
{"title":"斑点跟踪超声心动图和生物标志物检测心脏移植后急性细胞排斥反应的有效性。","authors":"Cecilia Beatriz Bittencourt Viana Cruz, Ludhmila A Hajjar, Fernando Bacal, Marco S Lofrano-Alves, Márcio S M Lima, Maria C Abduch, Marcelo L C Vieira, Hsu P Chiang, Juliana B C Salviano, Isabela Bispo Santos da Silva Costa, Julia Tizue Fukushima, Joao C N Sbano, Wilson Mathias, Jeane M Tsutsui","doi":"10.1186/s12947-020-00235-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation.</p><p><strong>Methods: </strong>We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment.</p><p><strong>Results: </strong>Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 - 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09-1.31) vs 0.05 ng/mL (0.01-0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68-0.92), 0.89 (0.81-0.93) and 0.79 (0.66-0.92), respectively.</p><p><strong>Conclusion: </strong>Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.</p>","PeriodicalId":9613,"journal":{"name":"Cardiovascular Ultrasound","volume":"19 1","pages":"6"},"PeriodicalIF":1.9000,"publicationDate":"2021-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12947-020-00235-w","citationCount":"9","resultStr":"{\"title\":\"Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation.\",\"authors\":\"Cecilia Beatriz Bittencourt Viana Cruz, Ludhmila A Hajjar, Fernando Bacal, Marco S Lofrano-Alves, Márcio S M Lima, Maria C Abduch, Marcelo L C Vieira, Hsu P Chiang, Juliana B C Salviano, Isabela Bispo Santos da Silva Costa, Julia Tizue Fukushima, Joao C N Sbano, Wilson Mathias, Jeane M Tsutsui\",\"doi\":\"10.1186/s12947-020-00235-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation.</p><p><strong>Methods: </strong>We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment.</p><p><strong>Results: </strong>Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 - 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09-1.31) vs 0.05 ng/mL (0.01-0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68-0.92), 0.89 (0.81-0.93) and 0.79 (0.66-0.92), respectively.</p><p><strong>Conclusion: </strong>Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.</p>\",\"PeriodicalId\":9613,\"journal\":{\"name\":\"Cardiovascular Ultrasound\",\"volume\":\"19 1\",\"pages\":\"6\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2021-01-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1186/s12947-020-00235-w\",\"citationCount\":\"9\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Ultrasound\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12947-020-00235-w\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Ultrasound","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12947-020-00235-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 9
摘要
背景:急性细胞排斥反应(ACR)是心脏移植术后的主要并发症。心内膜心肌活检(EMB)仍然是其诊断的金标准，但它有一些并发症。我们评估了斑点跟踪超声心动图(STE)和生物标志物在心脏移植后检测ACR的有效性。方法:前瞻性研究60例左、右心室收缩功能正常的移植患者，在移植后6个月行EMB监测。60名年龄和性别匹配的健康个体构成对照组。术前分析常规超声心动图参数、左心室整体纵向、径向和周向应变(LV-GLS、LV-GRS和LV-GCS)、左心室收缩扭转(LV-twist)和右心室游离壁纵向应变(RV-FWLS)。我们同时还测量了生物标志物。结果:60例患者中，17例(28%)有严重ACR(≥2R级)，43例(72%)无显著ACR (0 - 1R级)。ACR程度≥2r的移植患者LV-GLS、LV-twist和RV-FWLS的绝对值低于无ACR的移植患者(12.5%±2.9% vs 14.8%±2.3%，p=0.002;13.9°±4.8°vs 17.1°±3.2°，p=0.048;结论:与对照组相比，心脏移植患者左心室动力学发生了改变。肌钙蛋白与应变参数的结合对ACR的检测比单独的变量具有更高的准确性，这种关联可能会选择ACR风险较高的患者，这些患者将在心脏移植后的第一年接受EMB手术。
Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation.
Background: Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation.
Methods: We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment.
Results: Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 - 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09-1.31) vs 0.05 ng/mL (0.01-0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68-0.92), 0.89 (0.81-0.93) and 0.79 (0.66-0.92), respectively.
Conclusion: Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.
期刊介绍：
Cardiovascular Ultrasound is an online journal, publishing peer-reviewed: original research; authoritative reviews; case reports on challenging and/or unusual diagnostic aspects; and expert opinions on new techniques and technologies. We are particularly interested in articles that include relevant images or video files, which provide an additional dimension to published articles and enhance understanding.
As an open access journal, Cardiovascular Ultrasound ensures high visibility for authors in addition to providing an up-to-date and freely available resource for the community. The journal welcomes discussion, and provides a forum for publishing opinion and debate ranging from biology to engineering to clinical echocardiography, with both speed and versatility.
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