Impaired Right Ventricular Function in Heart Transplant Rejection.
- 作者列表："Carrion LJBM","Sperotto A","Nazario R","Goldraich LA","Clausell N","Rohde LE","Santos ABS
BACKGROUND:The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients. OBJECTIVES:Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection. METHODS:Patients who underwent HTx in a single center (2015 - 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant Results: Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e' ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (-23.0 ± 4.4% in the 0R/1R group vs. -20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group. CONCLUSION:In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.
背景: 在心脏移植 (HTx) 受者中，筛查并发症的实践提供了高存活率。 目的: 我们的目的是评估左心室 (LV) 和右心室 (RV) 整体纵向应变 (GLS) 的变化是否与细胞排斥相关。 方法: 在单中心 (2015 - 2016; n = 19) 接受HTx的患者被纳入本回顾性分析。共评估了170例活检和相应的超声心动图。在无或轻度 (0R/1R) 细胞排斥 (分别为n = 130和n = 25) 和中度 (2R) 排斥发作 (n = 15) 的活检/超声心动图对之间进行比较。P值 <0.05被认为是统计学上显著的结果: 大多数患者是48 ± 58% 岁的女性 (12.4)。与0R/1R排斥反应患者的超声心动图相比，具有2R活检的患者的超声心动图显示与另一组相比更大的LV后壁厚度、E/e' 比率和E/A比率。两组间左室收缩功能无差异。另一方面，当通过TAPSE、S波和RV分数面积变化评估时，2R组的RV收缩功能比另一组降低更多 (均p <0.05)。此外，RV GLS (0R/1R组为-23.0 ± 4.4%，2R组为-20.6 ± 4.9%，p = 0.038) 在2R组比0R/1R组降低更多。 结论: 在HTx受体中，中度急性细胞排斥与RV收缩功能障碍相关，通过RV应变以及常规超声心动图参数评估。若干超声心动图参数可用于筛选细胞排斥。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.