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Predictive Parameters of Decreased Left Ventricular Global Longitudinal Strain at 1 Month After Pediatric Heart
Jihye You1, Jeong Jin Yu2, Mi Jin Kim3
1Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea.
Insights
Pediatric heart transplant recipients often show reduced left ventricular global longitudinal strain (LVGLS) post-surgery. Preoperative factors like LV mass z-score, recipient age, and donor age predict this early decline, aiding in patient management.
Area of Science:
- Cardiology
- Pediatric Transplant Medicine
- Echocardiography
Background:
- Pediatric heart transplant recipients commonly experience a temporary decrease in left ventricular global longitudinal strain (LVGLS) post-surgery.
- This strain typically recovers within 1-2 years, but early prediction of decline is crucial for management.
Purpose of the Study:
- To identify preoperative predictors of left ventricular global longitudinal strain (LVGLS) decline at one month post-pediatric heart transplant.
- To assess the relationship between preoperative parameters and early postoperative cardiac function.
Main Methods:
- Retrospective analysis of 46 pediatric heart transplant recipients with available 2D echocardiographic data.
- Exclusion of patients with cardiac allograft vasculopathy or recent rejection episodes.
- Speckle tracking echocardiography used to measure LVGLS; logistic regression for predictor analysis.
Main Results:
- Mean LVGLS was significantly lower at 1 month (-15.5%) compared to 1 year (-19.4%) post-transplant (p < 0.001).
- Univariate analysis identified higher LV mass z-score (OR 1.452), recipient age (OR 1.124), and donor age (OR 1.081) as predictors of LVGLS decline.
- Multivariate analysis showed a trend for LV mass z-score predicting decline (p=0.087).
Conclusions:
- Preoperative LV mass z-score, recipient age, and donor age are associated with early LVGLS decline after pediatric heart transplantation.
- These findings may help identify at-risk patients for closer monitoring and tailored interventions.
- Donor/recipient weight ratio correlates with LV mass z-score, suggesting its role in early graft adaptation.
Abstract:
Previous reports indicate that the decreased left ventricular global longitudinal strain (LVGLS) seen in the early postoperative period of pediatric heart transplant patients generally recovers over the course of 1-2 years. In this study, we investigate the predictive capacity of preoperative parameters on the LVGLS decline seen at 1 month post transplant. Forty-six transplant subjects with 2D echocardiographic images sufficient for speckle tracking echocardiography were enrolled. We excluded patients diagnosed with cardiac allograft vasculopathy or with an episode of rejection 1 month before or after their echocardiographic examinations. The mean LVGLS was significantly reduced at 1 month when compared to 1 year following transplant (- 15.5% vs. - 19.4%, respectively, p < 0.001). The predictors of LVGLS that decline at 1 month were the LV mass z-score [odds ratio (OR) 1.452; 95% confidence interval (CI) 1.007-2.095, p = 0.046], recipient age (OR 1.124; 95% CI 1.015-1.245, p = 0.025), and donor age (OR 1.081; 95% CI 1.028-1.136, p = 0.002) in the univariate logistic regression analyses. Although multivariate analysis yielded no significant predictors, higher LV mass z-scores showed a trend associated with the decline of LVGLS (p = 0.087). The donor/recipient weight ratio was associated with the LV mass z-score (R2 = 0.412, p < 0.001).
