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Decreased Global Myocardial Work Efficiency Correlates with Coronary Vasculopathy in Pediatric Heart Transplant Patients
Pediatric Cardiology ( IF 1.6 ) Pub Date : 2021-10-15 , DOI: 10.1007/s00246-021-02748-1
Sarah Pradhan 1 , Anna Mullikin 1 , Huaiyu Zang 2 , Nicholas J Ollberding 2, 3 , Shelly Stark 1 , Garick D Hill 1, 3 , Clifford Chin 1, 3 , Justin T Tretter 1, 3
Affiliation  

Coronary angiography remains the standard for diagnosis of cardiac transplant vasculopathy (CAV), but it is invasive. Non-invasively derived left ventricle (LV) global myocardial work (GMW) indices have not been evaluated. We aimed to assess for correlations between LV GMW and the presence of CAV in a pediatric population. 24 heart transplant patients and 24 normal controls were prospectively enrolled. Patients were age-matched into groups with: orthotopic heart transplant and CAV (OHT-CAV; 6 patients, 33% male, mean age 13.5 years [SD 4.2]), orthotopic heart transplant without CAV (OHT; 18 patients, 67% male, mean age 11.1 years [SD 4.8]), and normal healthy controls (42% male, mean age 12.8 years [SD 5.0]). Transplant patients underwent cardiac catheterization with coronary angiography within 3 months of echocardiogram. Post-processing of echocardiograms with speckle-tracking echocardiography and derivation of GMW indices was performed. OHT-CAV patients had decreased global work efficiency (GWE) compared to OHT (mean difference = 7.01 [1.76, 12.25], adjusted p < 0.01). LV global longitudinal strain (GLS) and LV ejection fraction were not different between groups. Both global work index and GWE were decreased in OHT-CAV and OHT when compared to normal controls (OHT-CAV 1311.23 mmHg% vs OHT 1426.22 mmHg% vs controls 1802.81 mmHg%, adjusted p < 0.01; OHT-CAV 83.87% vs. OHT 90.87% vs. controls 95.41%, adjusted p < 0.01). GWE correlated negatively with the presence of CAV (r = − 0.44 [− 0.72, − 0.05]). This pilot study demonstrates decreased GWE correlates with pediatric CAV. This supports the need for further investigation of this promising diagnostic tool.



中文翻译:

全球心肌工作效率下降与小儿心脏移植患者的冠状动脉病变相关

冠状动脉造影仍然是诊断心脏移植血管病 (CAV) 的标准,但它是侵入性的。尚未评估非侵入性衍生的左心室 (LV) 整体心肌功 (GMW) 指数。我们旨在评估 LV GMW 与儿科人群中 CAV 存在之间的相关性。前瞻性招募了 24 名心脏移植患者和 24 名正常对照。患者年龄匹配分组:原位心脏移植和 CAV(OHT-CAV;6 名患者,33% 男性,平均年龄 13.5 岁 [SD 4.2]),无 CAV 原位心脏移植(OHT;18 名患者,67% 男性,平均年龄 11.1 岁 [SD 4.8])和正常健康对照(42% 男性,平均年龄 12.8 岁 [SD 5.0])。移植患者在超声心动图后 3 个月内接受了心脏导管插入术和冠状动脉造影。使用斑点追踪超声心动图对超声心动图进行后处理并推导 GMW 指数。与 OHT 相比,OHT-CAV 患者的整体工作效率 (GWE) 降低(平均差 = 7.01 [1.76, 12.25],调整后p  < 0.01)。LV 整体纵向应变 (GLS) 和 LV 射血分数在各组之间没有差异。与正常对照组相比,OHT-CAV 和 OHT 的全球工作指数和 GWE 均下降(OHT-CAV 1311.23 mmHg% vs OHT 1426.22 mmHg% vs 对照组 1802.81 mmHg%,调整后p  < 0.01;OHT-CAV 83.87% vs. OHT 90.87% 与对照组 95.41%,调整后的p  < 0.01)。GWE 与 CAV 的存在呈负相关 ( r  = − 0.44 [− 0.72, − 0.05])。这项初步研究表明 GWE 降低与儿科 CAV 相关。这支持对这种有前途的诊断工具进行进一步研究的需要。

更新日期:2021-10-15
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