Noninvasive Detection of Cardiac Allograft Vasculopathy by Stress Exercise Echocardiographic Assessment of Myocardial Deformation
| Autor: | Hendrik J. Harms, Tor Skibsted Clemmensen, Jørgen Frøkiær, Hans Eiskjær, Kirsten Bouchelouche, Brian Bridal Løgstrup, Camilla Molich Hoff, Lars Poulsen Tolbod, Steen Hvitfeldt Poulsen |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Doppler echocardiography Cardiac allograft vasculopathy Sensitivity and Specificity 030218 nuclear medicine & medical imaging Coronary artery disease 03 medical and health sciences Ventricular Dysfunction Left 0302 clinical medicine Hardness Internal medicine Elastic Modulus Image Interpretation Computer-Assisted Medicine Humans Radiology Nuclear Medicine and imaging Heart transplantation Ejection fraction medicine.diagnostic_test business.industry Coronary flow reserve Reproducibility of Results Stroke Volume Stroke volume medicine.disease Positron emission tomography Echocardiography Cardiology Exercise Test cardiovascular system Elasticity Imaging Techniques Heart Transplantation Female Stress Mechanical Cardiology and Cardiovascular Medicine business |
| Zdroj: | Clemmensen, T S, Eiskjær, H, Løgstrup, B B, Tolbod, L P, Harms, H J, Bouchelouche, K, Hoff, C, Frøkiær, J & Poulsen, S H 2016, ' Noninvasive Detection of Cardiac Allograft Vasculopathy by Stress Exercise Echocardiographic Assessment of Myocardial Deformation ', Journal of the American Society of Echocardiography, vol. 29, no. 5, pp. 480-90 . https://doi.org/10.1016/j.echo.2016.01.012 |
| DOI: | 10.1016/j.echo.2016.01.012 |
| Popis: | BACKGROUND: The aim of this study was to evaluate the value of noninvasive assessment of cardiac allograft vasculopathy (CAV) in heart-transplanted patients by exercise stress myocardial deformation and coronary flow reserve (CFR) assessment.METHODS: Fifty-eight heart-transplanted patients underwent semisupine exercise echocardiography with assessment of left ventricular (LV) longitudinal myocardial deformation. CAV was assessed by coronary angiography and noninvasive CFR by (15)O-H2O positron emission tomographic imaging and Doppler echocardiography. Patients were divided into three groups on the basis of angiographic CAV: no CAV (n = 21), mild CAV (n = 19), and severe CAV (n = 18).RESULTS: Patients with severe CAV had significantly lower LV global longitudinal strain (GLS) at rest (no CAV, -16 ± 2%; mild CAV, -15 ± 2%; severe CAV, -12 ± 4%; P < .001), failed to increase LV GLS during exercise (no CAV, -5.7 ± 2.0%; mild CAV, -3.3 ± 2.9%; severe CAV, -0.2 ± 2.8%; P < .0001), and had significantly lower echocardiographic coronary flow velocity reserve (CFVR) (no CAV, 3.2 ± 0.4; mild CAV, 2.7 ± 0.7; severe CAV, 1.8 ± 0.5; P < .0001) and PET CFR (no CAV, 3.4 ± 0.9; mild CAV, 3.1 ± 0.9; severe CAV, 1.9 ± 0.8; P < .0001). Furthermore, patients with mild CAV had significantly lower exercise LV GLS and echocardiographic CFVR than patients with no CAV. Exercise LV GLS, echocardiographic CFVR, and PET CFR were significantly correlated with the presence of severe CAV in a logistic regression model (LV GLS odds ratio, 0.71; 95% CI, 0.60-0.84; P < .0001; echocardiographic CFVR odds ratio: 0.06; 95% CI, 0.01-0.23; PET CFR odds ratio, 0.17; 95% CI, 0.07-0.46). This relation remained significant after adjustment for symptoms and time since transplantation.CONCLUSIONS: Noninvasive assessment of LV longitudinal myocardial deformation during exercise is feasible and strongly associated with the presence and degree of CAV. Exercise stress myocardial deformation analysis, echocardiographic CFVR, or PET CFR may serve as a noninvasive model for the detection of CAV. |
| Databáze: | OpenAIRE |
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