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A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type
Bethany L Wisotzkey1, Bereketeab Haileselassie2, Neal Jorgensen3
1Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA.
Insights
Biomarkers like B-type natriuretic peptide and echocardiographic measures can help assess diastolic function in pediatric heart transplant patients. These non-invasive tools aid in monitoring graft health and detecting issues early.
Area of Science:
- Cardiology
- Pediatric Transplant Medicine
- Diagnostic Imaging
Background:
- Longitudinal assessment of allograft diastolic function is crucial for pediatric heart transplant recipients.
- Detecting acute rejection, cardiac allograft vasculopathy, and graft dysfunction early is vital.
- Cardiac catheterization provides reference standards for diastolic pressures, but echocardiography offers a non-invasive alternative for serial surveillance.
Purpose of the Study:
- To identify factors associated with post-transplant mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP).
- To evaluate the role of B-type natriuretic peptide (BNP) and echocardiographic parameters in assessing diastolic function.
- To establish non-invasive markers for monitoring heart transplant recipients.
Main Methods:
- A retrospective review included 143 cardiac catheterizations and echocardiograms from 56 pediatric heart transplant recipients (2007-2011).
- Patients with rejection were excluded from the analysis.
- Univariate and multivariate linear regression models were used to analyze hemodynamic, echocardiographic, and BNP data.
Main Results:
- B-type natriuretic peptide (BNP), heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e', and septal thickening were independently associated with mean right atrial pressure.
- BNP, heart rate z-score, LV end-diastolic dimension z-score, LV mass, and mitral E/e' were independently associated with mean pulmonary capillary wedge pressure.
- BNP levels correlated with pulmonary artery pressures, height, hemoglobin, fractional shortening, septal thickening, and pulmonary vascular resistance index.
Conclusions:
- B-type natriuretic peptide and echocardiographic indices of diastolic function are independently related to post-transplant pressures in pediatric heart transplant recipients.
- These non-invasive markers can aid in the longitudinal assessment of allograft diastolic function.
- Findings support the use of BNP and echocardiography for monitoring graft health without rejection.
Background:
Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters.
Methods:
A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data.
Results:
Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e', and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e' were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index.
Conclusions:
B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.
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