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Early assessment of right ventricular systolic function after pediatric heart transplant

Jamie K Harrington1, Lindsay R Freud1, Kristal L Woldu1

  • 1Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University Medical Center, New York, New York.

Pediatric Transplantation
|September 5, 2018
PubMed

Insights

Quantitative measures of right ventricular (RV) systolic function were markedly abnormal early after pediatric heart transplant (HT), contrasting with qualitative assessments. Standard reference values may not apply in this critical post-transplant period.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Transplant Medicine

Background:

  • Right ventricular (RV) systolic function is crucial in the early period following heart transplantation (HT).
  • Quantitative echocardiographic assessment of RV systolic function in pediatric HT recipients is not well-established.
  • Understanding RV function post-HT is vital for patient management and outcomes.

Purpose of the Study:

  • To describe validated quantitative echocardiographic measures of RV systolic function early after pediatric HT.
  • To evaluate associations between quantitative RV function and qualitative assessments.
  • To explore relationships between RV function and clinical factors in pediatric HT patients.

Main Methods:

  • Quantitative echocardiography was performed >24 hours post-cardiopulmonary bypass in 145 pediatric HT patients.
  • Measures included two-dimensional tricuspid annular plane systolic excursion (TAPSE), S', fractional area change (FAC), and myocardial performance index (MPI).
  • RV function was assessed quantitatively and qualitatively, with associations to clinical factors analyzed.

Main Results:

  • Quantitative RV systolic function was markedly abnormal: mean TAPSE z-score -8.43, S' z-score -4.36, FAC 24.4%, and MPI 0.86.
  • Few patients demonstrated normal quantitative function (TAPSE 0%, S' 1.2%, FAC 9.4%, MPI 28.4%).
  • Qualitative assessment showed normal function in 48.3% of patients, and most clinical factors were not associated with RV function.

Conclusions:

  • Quantitative RV systolic function is significantly impaired early after pediatric HT, despite reassuring qualitative assessments.
  • Current standard reference values for TAPSE, S', FAC, and MPI may not be applicable in the early post-HT period.
  • Developing adapted reference values for RV systolic function is necessary for accurate assessment in pediatric HT survivors.

Keywords:
echocardiographypediatric heart transplantright ventriclesystolic function

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