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Published on: August 2, 2024
Longer Ischemic Time is Associated with Increased Ventricular Stiffness as Measured by Pressure-Volume Loop Analysis
Luke W Schroeder1, Shahryar M Chowdhury2, Ali L Burnette2
1Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA. schroedl@musc.edu.
Insights
Longer ischemic times in pediatric heart transplant recipients are linked to increased left ventricular stiffness. No other clinical factors were significantly associated with cardiac dysfunction measured by pressure-volume loops.
Area of Science:
- Cardiology
- Pediatric Transplant Medicine
- Cardiac Physiology
Background:
- Pediatric heart transplantation outcomes require ongoing assessment of cardiac function.
- Pressure-volume loops (PVLs) offer detailed insights into cardiac mechanics.
Purpose of the Study:
- To investigate associations between clinical factors and cardiac function using PVLs in pediatric heart transplant recipients.
- To identify potential indicators of cardiac dysfunction post-transplant.
Main Methods:
- Enrolled pediatric patients (<20 years) undergoing clinically indicated catheterization post-heart transplant.
- Recorded PVLs using microconductance catheters, collecting data on contractility, ventricular-arterial coupling, and stiffness.
- Correlated PVL measures with demographic data, B-type natriuretic peptide (BNP), time from transplant, ischemic time, and immunological factors.
Main Results:
- Eighteen pediatric heart transplant recipients were analyzed.
- Longer ischemic time showed a significant association with increased left ventricular stiffness (Beta index, r=0.49, p=0.05).
- No other single clinical variable, including rejection history or donor-specific antibodies, correlated significantly with PVL-derived cardiac function parameters.
Conclusions:
- Longer ischemic times are associated with increased left ventricular stiffness in pediatric heart transplant recipients.
- Current clinical factors, apart from ischemic time, do not appear to be strong predictors of cardiac dysfunction as assessed by PVLs in this cohort.
Background:
The purpose of this study was to investigate the associations between clinical factors and cardiac function as measured by pressure-volume loops (PVLs) in a pediatric heart transplant cohort.
Methods:
Patients (age < 20 years) who underwent heart transplantation presenting for a clinically indicated catheterization were enrolled. PVLs were recorded using microconductance catheters (CD Leycom®, Zoetermeer, Netherlands). Demographic data, serum B-type natriuretic peptide (BNP), time from transplant, ischemic time, presence of transplant coronary artery disease, donor-specific antibodies, and history of rejection were recorded at the time of catheterization. PVL data included contractility indices: end-systolic elastance and preload recruitable stroke work; ventricular-arterial coupling index; ventricular stiffness constant, Beta; and isovolumic relaxation time constant, tau. Associations between PVL measures and clinical data were investigated using non-parametric statistical tests.
Results:
A total of 18 patients were enrolled. Median age was 8.7 years (IQR 5-14 years). There were ten males and eight females. Six patients had a history of rejection and ten had positive donor-specific antibodies. There was no transplant coronary artery disease. Median BNP was 100 pg/mL (IQR 46-140). Time from transplant to PVL obtained during catheterization procedure was 4.1 years (IQR 1.7-7.8 year). No single clinical characteristic was statistically significant when correlated with PVL data. However, longer ischemic time was associated with worse Beta (r = 0.49, p = 0.05).
Conclusions:
Our study found that longer ischemic times are associated with increased left ventricular stiffness. No other single clinical variable is associated with cardiac dysfunction as determined by PVL analysis.
