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Right ventricular function during exercise in children after heart transplantation.

B Cifra¹, C T Morgan¹, A Dragulescu¹

¹Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.

European Heart Journal. Cardiovascular Imaging

|June 29, 2017

Summary

Pediatric heart transplant recipients show preserved right ventricular (RV) systolic and diastolic function during exercise, with normal increases in tissue Doppler imaging velocities and strain. However, myocardial acceleration during isovolumic contraction (IVA) may be blunted, suggesting a potential mild decrease in RV contractile response.

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Area of Science:

Cardiology
Pediatric Cardiology
Transplantation Medicine

Background:

Right ventricular (RV) dysfunction is a significant concern following heart transplantation (HTx).
Assessing RV systolic and diastolic reserve is crucial for managing pediatric HTx recipients.

Purpose of the Study:

To evaluate the RV systolic and diastolic reserve in pediatric heart transplant recipients using semi-supine bicycle ergometry (SSBE) stress echocardiography.
To compare RV functional parameters between pediatric HTx recipients and healthy controls during exercise.

Main Methods:

Thirty-nine pediatric HTx recipients and 23 controls underwent stepwise SSBE stress echocardiography.
Measurements included tissue Doppler imaging (TDI) peak systolic (s') and diastolic (e') velocities, myocardial acceleration during isovolumic contraction (IVA), and RV free wall longitudinal strain.
Analysis involved plotting parameters against incremental heart rates (HR) using regression models.

Main Results:

At rest, HTx recipients had higher HR but lower TDI velocities and RV IVA compared to controls. RV free wall longitudinal strain was similar.
At peak exercise, HTx recipients showed lower RV function measurements, except for longitudinal strain.
The increase in TDI velocities and strain with increasing HR was preserved in HTx recipients, but IVA increase was blunted.

Conclusions:

Pediatric HTx recipients demonstrate preserved RV systolic and diastolic functional response to exercise, with normal increases in TDI velocities and strain.
A blunted myocardial acceleration during isovolumic contraction (IVA) response in HTx recipients may suggest a mildly decreased RV contractile response, warranting further investigation.