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Published on: November 27, 2013
Echocardiographic Assessment of Right Ventricular Function in Clinically Well Pediatric Heart Transplantation
Brian R White1, Hannah Katcoff2, Jennifer A Faerber2
1Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Pediatric heart transplant recipients show reduced right ventricular function, particularly longitudinal shortening, compared to healthy children. Fractional area change (FAC) is relatively preserved, offering a potentially more reliable metric in this population.
Area of Science:
- Cardiology
- Pediatric Transplant Medicine
- Echocardiography
Background:
- Echocardiographic monitoring is crucial after pediatric heart transplantation due to risks of rejection and ventricular dysfunction.
- Adult studies indicate altered right ventricular function post-transplant, but pediatric data are limited.
Purpose of the Study:
- To assess right ventricular systolic function in pediatric heart transplant recipients using echocardiography.
- To establish normative data for right ventricular function metrics in this population.
Main Methods:
- Retrospective analysis of echocardiograms from 127 pediatric heart transplant recipients, remote from adverse events.
- Measurement of tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S').
- Comparison with 380 healthy, age-matched control subjects.
Main Results:
- Pediatric heart transplant recipients had significantly lower TAPSE (Z score -3.38) and S' values compared to controls.
- FAC was also significantly decreased, but 83% of transplant patients fell within the normal range.
- Longitudinal measures (TAPSE and S') were more affected than FAC.
Conclusions:
- Pediatric heart transplant recipients exhibit diminished right ventricular systolic function, with longitudinal parameters being particularly impaired.
- Fractional area change (FAC) is relatively preserved and may serve as a more robust echocardiographic metric in this cohort.
- Established nomograms aid in quantifying functional changes in pediatric heart transplant patients.
Background:
Echocardiographic follow-up after pediatric heart transplantation is important because of the lifelong risk for rejection and resultant ventricular dysfunction. Although adult studies have shown that echocardiographic measures of right ventricular function are changed after transplantation, similar results have not been reported in the pediatric population.
Methods:
A single-center retrospective study of echocardiograms obtained among pediatric heart transplant recipients was conducted. All echocardiograms were selected remote from transplantation, rejection, or graft vasculopathy. These criteria identified 127 patients. Right ventricular systolic function was measured using tricuspid annular plane systolic excursion, fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S'). Results were compared with those in 380 healthy age-matched echocardiographic control subjects.
Results:
Tricuspid annular plane systolic excursion values in pediatric heart transplant recipients were significantly lower than in control subjects at all ages (P < .0001), with a mean Z score of -3.38. FAC and S' did not vary by age in control patients >6 months of age. FAC values in transplantation patients were significantly decreased compared with those in control subjects (P < .0001), but 83% of transplantation patients had FAC values within the control-derived normal range. S' values were also significantly lower in transplantation patients than control subjects (P < .0001).
Conclusions:
Heart transplantation patients have significantly decreased quantitative metrics of right ventricular function relative to healthy control subjects; longitudinal shortening (tricuspid annular plane systolic excursion and S') is particularly affected. FAC is relatively preserved and may be a better metric in this population. These results establish nomograms of RV function in pediatric heart transplantation patients and in normal pediatric control subjects, which may allow quantification of changes in this vulnerable population.
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