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Published on: July 18, 2014
Altered Biatrial Phasic Function after Heart Transplantation in Children
Anitha Parthiban1, Vivek Jani2, Jin Zhang2
1Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.
Insights
Pediatric heart transplant recipients show impaired left and right atrial function, impacting reservoir, conduit, and booster roles. This disruption in atrial function may stem from underlying diastolic dysfunction.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplantation Medicine
Background:
- Pediatric heart transplantation (HT) is a life-saving procedure.
- Assessing the long-term function of cardiac structures post-transplantation is crucial for patient outcomes.
- Atrial function plays a vital role in overall cardiac hemodynamics.
Purpose of the Study:
- To investigate alterations in left and right atrial (LA and RA) phasic function in pediatric heart transplant (HT) patients.
- To explore the relationship between atrial function and HT-related clinical variables.
Main Methods:
- Two-dimensional echocardiographic speckle-tracking was used to measure atrial deformation indices (strain and strain rates).
- Phasic atrial function components (reservoir, conduit, booster) were calculated for both LA and RA.
- Comparisons were made between 36 HT recipients and 50 healthy children, with correlations to clinical data.
Main Results:
- Pediatric HT recipients exhibited reduced reservoir, conduit, and booster function in both LA and RA compared to controls.
- No significant relationship was found between atrial deformation and age at HT, bypass time, or ischemia time.
- LA conduit function showed a weak correlation with donor age, and RA function correlated with the duration of HT.
Conclusions:
- Atrial strain analysis is feasible in pediatric HT recipients.
- Disruption of reservoir, conduit, and booster function is evident in both atria post-HT.
- Ventricular diastolic dysfunction is speculated as a potential cause for the observed atrial dysfunction.
Purpose:
We used two-dimensional echocardiographic speckle-tracking to investigate whether left and right atrial (LA and RA) phasic function in pediatric heart transplantation (HT) patients is altered and explored the relationship to HT-related clinical variables.
Methods:
Eighty-six subjects (36 HT and 50 normal children) were prospectively enrolled in two centers. Clinical data included age at HT, bypass time, ischemia time, donor age, and incidence of rejection. Atrial deformation indices including strain and strain rates (SRs) were measured using two-dimensional echocardiographic speckle-tracking. Components of phasic atrial function-reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) were calculated. Comparisons with controls were made using t test or Kruskal-Wallis test, and correlations to clinical variables were explored.
Results:
The mean age and body surface area of HT subjects were 10.2 ± 6.2 years and 1.2 ± 0.6 m2, respectively. The mean heart rates were higher in HT (96 ± 18 vs 88 ± 21 in controls). There were reductions in RA and LA reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) function in HT compared with controls. There was no relationship of LA and RA deformation indices with mean age at HT, bypass time, or ischemia time. The LA εcd correlated weakly with donor age (r = -0.49, P = .04) and RA SRr, and SRcd showed association with duration of HT (P < .05). Nineteen HT recipients had follow-up studies 0.24 ± 0.18 years after the first examination, and deformational indices were not significantly changed.
Conclusions:
Atrial strain determination is feasible in pediatric HT recipients and demonstrates disruption of reservoir, conduit, and booster function of both atria in this population; we speculate this may be a consequence of ventricular diastolic dysfunction.
