肝移植候选人的心脏评估。

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-08-01 Epub Date: 2023-11-23 DOI:10.1097/MOT.0000000000001122
Stephen Possick, Vandana Khungar, Ranjit Deshpande
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引用次数: 0

摘要

综述目的:本综述旨在总结成人肝移植候选人心脏评估的最新变化。在过去的几年中,冠状动脉计算机断层血管造影(CCTA)在有或没有分数血流储备(FFR)的情况下取得了重大进展,冠状动脉钙评分在阻塞性冠状动脉疾病的风险分层中的应用日益广泛。这导致了考虑肝移植的肝硬化患者风险分层的新策略,以及美国心脏协会(AHA)关于评估肝和肾移植候选人的最新立场文件。肝硬化心肌病的诊断已得到改进。这些新的诊断标准要求在所有患者中评估特定的超声心动图参数。超声心动图上肺动脉高压的定义已经改变,不再使用基于下腔静脉(IVC)大小和塌陷的右心房(RA)压力估计。这提供了更多的肺压力体积中性估计。最近发现:虽然CCTA具有突出的阴性预测价值,但假阳性结果并不罕见,通常需要进一步检查。修订的肝硬化心肌病诊断标准改善了围手术期容量超载和预后的风险分层。完善的肺动脉高压标准为右心导管(RHC)和转介到专科医生提供了更好的指导。关于TAVR治疗肝硬化严重主动脉瓣狭窄患者的安全性和有效性的新数据。总结:增加无创检测的使用,包括CCTA和/或冠状动脉钙评分,可以提高检测对阻塞性冠状动脉疾病的阴性预测价值,并可能减少对冠状动脉造影的依赖。2020年肝硬化心肌病标准的应用将改善收缩和舒张功能评估以及随后的围手术期风险分层。强调整体应变评分的使用,因为它提供了射血分数和舒张参数之外的重要信息。一个标准化的单参数回声切断为肺动脉压升高简化了评估和随访。创新的经皮瓣膜狭窄和反流技术为那些有手术风险的患者提供了新的选择。
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Cardiac evaluation of the liver transplant candidate.

Purpose of review: This review aims to summarize recent changes in the cardiac evaluation of adult liver transplant candidates. Over the last several years, there have been significant advances in the use of coronary computed tomography angiography (CCTA) with and without fractional flow reserve (FFR) and increasingly widespread availability of coronary calcium scoring for risk stratification for obstructive coronary artery disease. This has led to novel strategies for risk stratification in cirrhotic patients being considered for liver transplant and an updated American Heart Association (AHA) position paper on the evaluation of liver and kidney transplant candidates. The diagnosis of cirrhotic cardiomyopathy has been refined. These new diagnostic criteria require that specific echocardiographic parameters are evaluated in all patients. The definition of pulmonary hypertension on echocardiography has been altered and no longer utilizes right atrium (RA) pressure estimates based on inferior vena cava (IVC) size and collapse. This provides more volume neutral estimates of pulmonary pressure.

Recent findings: Although CCTA has outstanding negative predictive value, false positive results are not uncommon and often lead to further testing. Revised diagnostic criteria for cirrhotic cardiomyopathy improve risk stratification for peri-operative volume overload and outcomes. Refined pulmonary hypertension criteria provide improved guidance for right heart catheterization (RHC) and referral to subspecialists. There are emerging data regarding the safety and efficacy of TAVR for severe aortic stenosis in cirrhotic patients.

Summary: Increased utilization of noninvasive testing, including CCTA and/or coronary calcium scoring, can improve the negative predictive value of testing for obstructive coronary artery disease and potentially reduce reliance on coronary angiography. Application of the 2020 criteria for cirrhotic cardiomyopathy will improve systolic and diastolic function assessment and subsequent perioperative risk stratification. The use of global strain scores is emphasized, as it provides important information beyond ejection fraction and diastolic parameters. A standardized one-parameter echo cut-off for elevated pulmonary pressures simplifies both evaluation and follow-up. Innovative transcutaneous techniques for valvular stenosis and regurgitation offer new options for patients at prohibitive surgical risk.

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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
期刊最新文献
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