多普勒超声技术对心脏移植患者急性排斥反应时左室舒张功能指标的观察──与心内膜心肌活检对照研究

为进一步探讨多普勒超声技术早期检出急性心脏排斥反应的可能性和可靠性，对３１例首次心脏移植患者进行了系列多普勒超声检查和２４小时内相应的心内膜心肌活检对照研究。结果表明，急性心脏排斥反应时左室质量（ＬＶｍａｓｓ）明显高于排斥反应前（Ｐ＜０．０１）；左室等容舒张期（ＩＶＲＴ）及舒张期二尖瓣口压差减半时间（ＰＨＴ）均明显缩短（Ｐ＜０．０００１）；舒张早期二尖瓣前向峰值血流速度较排斥反应前明显增高（Ｐ＜０．０１）。经成功应用免疫抑制剂治疗后，上述４项指标均恢复至对照前水平，研究结果表明，利用多普勒趔声技术测定的左室舒张功能指标是早期检出并监测急性心脏排斥反应的可靠、简便方法。

DOPPLER ECHOCARDIOGRAPHIC STUDY OF LEFT VENTRICULAR DIASTOLIC FUNCTION INDEXES IN CARDIAC TRANSPLANT PATIENTS WITH ACUTE REJECTION

To assess the change in left ventricular diastolic function indexes by Doppler echocardiography in heart transplant patients with acute rejection,serial heppler echocardiographic studies followed by endomyocardial biopsy within 24 hr were performed in 31 patients aged 19 to 65 years(mean 48. 0). Left ventricular mass (LV mass), Isovolumic relaxation time(IVRT), pressure half-time(PHT),and peak early mitral flow velocity (E wave) were measured. The results showed that LV mass at the time of acute rejection significantly increased(p<0.01), IVRT, PHT were significantly sborter(p<0. 0001)with an increase in E wave. After successful immunosuppressive therapy, LV mass, IVRT,PHT,and E wave returned to values similar to those of baseline. These data showed that Deppler Echocardiographic assessment of left ventricular diastolic function provides a reliable and simple method for early detection of acute rejection and noninvasive monitoring of the heart transplant recipient. Temple University Hospital , Philadelphia,PA 19140, USA