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Published on: January 27, 2023
Association of pediatric heart transplant coronary vasculopathy with abnormal hemodynamic measures
Ranjit Aiyagari1, Melisa Nika, James G Gurney
1C.S. Mott Children's Hospital, Division of Pediatric Cardiology, University of Michigan Health Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. ranjita@med.umich.edu
Insights
Elevated ventricular filling pressures, including right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP), are associated with transplant coronary artery disease (TCAD) in pediatric heart transplant recipients. This finding may aid in earlier diagnosis and treatment of TCAD.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pediatric Cardiology
Background:
- Transplant coronary artery disease (TCAD) significantly limits long-term survival after heart transplantation (HTx).
- Early diagnosis of TCAD in pediatric HTx recipients is challenging, often occurring after symptoms develop.
Purpose of the Study:
- To investigate the association between abnormal catheter-derived filling pressures and the presence of TCAD in asymptomatic pediatric heart transplant recipients.
- To determine if elevated right ventricular end-diastolic pressure (RVEDP) or pulmonary capillary wedge pressure (PCWP) can predict TCAD.
Main Methods:
- Analysis of data from 52 presymptomatic pediatric HTx patients.
- Measurement of catheter-derived RVEDP and PCWP during routine surveillance catheterization.
- Verification of TCAD absence through biopsy to exclude rejection.
Main Results:
- TCAD was diagnosed in 38% of patients, with a significant proportion experiencing adverse outcomes (death or retransplantation).
- Patients with TCAD showed significantly higher RVEDP (9.5 ± 6.0 vs. 5.4 ± 4.7 mmHg; P=.005) and PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7 mmHg; P=.012) compared to non-TCAD patients.
- Elevated RVEDP (>10 mmHg) or PCWP (>12 mmHg) was strongly associated with TCAD (Odds Ratio = 5.2; P=.010).
Conclusions:
- Elevated ventricular filling pressures, specifically RVEDP and PCWP, measured during surveillance catheterization are associated with angiographic TCAD in pediatric heart transplant recipients.
- Identifying this association can lead to earlier detection and intervention for TCAD.
- Prompt diagnosis and treatment of TCAD may improve long-term cardiac allograft survival.
Objective:
Transplant coronary artery disease (TCAD) is the limiting factor to long-term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter-derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients. DESIGN, PATIENTS, OUTCOME MEASURES: Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheter-derived right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.
Results:
TCAD was diagnosed an average of 8.3 years post-HTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheter-derived pressure measurements showed that RVEDP was elevated in TCAD compared with non-TCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10 mm Hg or PCWP > 12 mm Hg was associated with TCAD (OR = 5.2; P= .010).
Conclusions:
In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.
