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Left atrial deformation predicts pulmonary capillary wedge pressure in pediatric heart transplant recipients
Jay Yeh1, Ranjit Aiyagari, Robert J Gajarski
1Department of Pediatrics, Division of Pediatric Cardiology, University of California Davis Medical Center, Sacramento, California.
Insights
Left atrial strain and distensibility show promise as noninvasive measures of pulmonary capillary wedge pressure in pediatric heart transplant patients, outperforming traditional E/E' ratios. LA distensibility offers better reproducibility for monitoring filling pressures.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplant Medicine
Background:
- Pulmonary capillary wedge pressure (PCWP) is critical for pediatric heart transplant recipients.
- Established noninvasive methods like E/E' have limitations in this population.
- Accurate assessment of left ventricular filling pressures is essential post-transplant.
Purpose of the Study:
- To evaluate left atrial (LA) peak systolic strain and distensibility as surrogates for PCWP.
- To compare these LA parameters with the E/E' ratio in pediatric heart transplant patients.
Main Methods:
- Echocardiography was performed immediately after cardiac catheterization in 38 pediatric heart transplant recipients.
- Measurements included E/E' ratio, peak LA systolic longitudinal strain, and LA distensibility.
- These echocardiographic parameters were correlated with invasively measured PCWP.
Main Results:
- PCWP correlated significantly with peak LA systolic strain (r=-0.44) and LA distensibility (r=-0.43), but not E/E'.
- LA strain demonstrated a higher diagnostic accuracy (AUC=0.846) than LA distensibility (AUC=0.606) for elevated PCWP (≥12).
- LA distensibility exhibited superior intra-observer and inter-observer reproducibility compared to LA strain.
Conclusions:
- Peak LA systolic strain and LA distensibility may serve as valuable noninvasive indicators of left ventricular filling pressure in pediatric heart transplant patients.
- LA distensibility offers better reproducibility, while LA strain shows higher diagnostic capability.
- Further longitudinal studies are required to assess the clinical utility of these parameters in tracking PCWP changes and patient outcomes.
Background:
Pulmonary capillary wedge pressure (PCWP) is an important indicator in pediatric heart transplant patients, but commonly used noninvasive surrogates, such as ratio of early diastolic mitral inflow velocity to annular velocity (E/E'), have limitations in this population. This study aimed to evaluate the relation of left atrial (LA) peak systolic strain and distensibility with PCWP in pediatric heart transplant recipients.
Methods:
Consecutive pediatric heart transplant patients were enrolled at time of cardiac catheterization, with echocardiogram immediately afterward. E/E' ratio at the lateral and medial mitral annulus, peak LA systolic longitudinal strain by speckle tracking, and LA distensibility were measured from echocardiograms and compared to invasively measured PCWP.
Results:
In 38 patients (11.1 ± 5.8 years old), PCWP correlated with peak LA systolic strain (r = -0.44, P = 0.01) and LA distensibility (r= -0.43, P = 0.02), but not with E/E'. On receiver operating characteristics analysis, LA strain had a higher area under the curve than LA distensibility (0.846 vs. 0.606). LA strain <18.9% had sensitivity 62% and specificity 95%, with likelihood ratio 12.3 for PCWP ≥12. However, LA strain had lower intra-observer and inter-observer reproducibility than distensibility (intra-class correlation coefficients 0.89 and 0.75 vs. 0.93 and 0.90).
Conclusions:
Peak LA systolic strain and LA distensibility may be more useful surrogates of left ventricular filling pressure than E/E' in the pediatric heart transplant population, with greater reproducibility of LA distensibility. Longitudinal studies are needed to evaluate which parameters track changes in PCWP and clinical outcome.
