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A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Echocardiography to predict left ventricular filling pressure for long-term paediatric heart transplant patients
Fahad A Alfares1,2, Chetan Nanjegowda2, Sethuraman Swaminathan2
1Pediatric Cardiology Unit, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
Insights
Traditional echocardiographic indices do not reliably assess diastolic function in pediatric heart transplant recipients long-term. These measures failed to correlate with invasive hemodynamic pressures, indicating a need for improved assessment methods post-transplant.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplantation Medicine
Background:
- Left ventricular diastolic dysfunction is a known complication in pediatric heart transplant recipients.
- Standard echocardiographic measures often show poor correlation with immediate post-transplant left ventricular filling pressures.
Purpose of the Study:
- To evaluate the long-term correlation between traditional echocardiographic indices of diastolic function and invasive hemodynamic pressures in pediatric heart transplant patients.
- To determine if established echocardiographic parameters can accurately reflect left ventricular filling pressures years after transplantation.
Main Methods:
- Retrospective review of 41 pediatric heart transplant recipients (median age at transplant 12.1 years, median follow-up 11 years).
- Comparison of echocardiographic data (mitral inflow E velocity, E/A ratio, tissue Doppler velocities, E/e', mitral deceleration time, isovolumetric relaxation time) with invasive measurements (pulmonary capillary wedge pressure, left ventricular end-diastolic pressure) from cardiac catheterization.
Main Results:
- No significant correlation was found between traditional echocardiographic indices of diastolic function and elevated pulmonary capillary wedge pressure or left ventricular end-diastolic pressure.
- Specific indices like mitral E velocity, E/A ratio, tissue Doppler velocities, and E/e' did not correlate with invasive measures.
- Mitral valve deceleration time and isovolumetric relaxation time also showed no correlation with elevated invasive pressures.
Conclusions:
- Traditional echocardiographic indices for assessing diastolic function lack long-term correlation with invasive hemodynamic measurements in pediatric heart transplant survivors.
- These findings highlight limitations in using standard echocardiography to monitor diastolic function and filling pressures in this population over time.
Objectives:
Left ventricular diastolic dysfunction is a recognised sequela following transplantation in paediatric heart transplant patients. Traditional echocardiographic indices do not correlate well with left ventricular filling pressure immediately after transplantation. This study aimed to assess whether these indices have any long-term correlation after transplantation in paediatric patients.
Methods:
A retrospective chart review of 41 patients who had a heart transplant before the age of 24 years was performed. The median time since the transplantation was 11 years. Data obtained from surveillance cardiac catheterisation and echocardiographic examination were reviewed. Traditional echocardiographic indices of diastolic function were compared with the pulmonary capillary wedge pressure and left ventricular end-diastolic pressure obtained from cardiac catheterisation.
Results:
The median age at transplant was 12.1 years, and the median time since transplant was 11 years. Eighteen patients (43%) had a history of at least one rejection episode and 12 patients (29%) had a history of cardiac allograft vasculopathy. There was no correlation between mitral inflow E velocity, mitral E/A ratio, tissue Doppler velocities, mitral E/e' (mitral inflow E velocity to mitral annular velocity), and elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. There was no correlation between mitral valve deceleration time or isovolumetric relaxation time with elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure.
Conclusion:
Our findings suggest that traditional echocardiographic indices of diastolic function do not correlate well with elevated invasive pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure in paediatric heart transplant patients' long-term post-transplantation.
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