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Published on: August 2, 2024
Natural recovery of cardiac allograft diastolic function, a retrospective longitudinal report
Shengyi Fu1, Aditi G M Patel1,2, Mohammed Ruzieh3
1College of Medicine, University of Florida, Gainesville, FL, United States of America.
Insights
Diastolic dysfunction after heart transplantation (HTx) often occurs. This study found that right atrial and ventricular filling pressures normalize by 12 weeks, with diastolic function recovery by 6 months post-HTx.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiac Imaging
Background:
- Diastolic dysfunction is a common early complication following heart transplantation (HTx), often attributed to ischemic injury.
- The natural trajectory of diastolic function recovery in cardiac allografts post-HTx has not been well-defined.
Purpose of the Study:
- To investigate the natural course of diastolic function recovery in adult heart allografts.
- To correlate right atrial (RA) strain with intracardiac pressure measurements post-HTx.
Main Methods:
- Retrospective review of 60 adult patients undergoing HTx between 2015 and 2021.
- Collection of invasive hemodynamic data and echocardiograms at multiple time points (2 weeks, 1, 3, 6, and 12 months post-HTx).
- Analysis of 2D feature tracking for RA strain and comparison with intracardiac pressure measurements.
Main Results:
- Normalization of right ventricular (RV) and RA filling pressures was observed by 12 weeks post-HTx.
- Recovery of diastolic dysfunction was evident by 6 months post-transplantation.
- An inverse correlation was found between RV end-diastolic pressure and RA contractile and reservoir functions.
Conclusions:
- Diastolic function and filling pressures in cardiac allografts show significant recovery within the first 6-12 months post-HTx.
- Right atrial indices derived from imaging show promise as non-invasive markers for allograft surveillance.
- Incorporating right atrial indices into imaging surveillance protocols may be valuable as invasive monitoring decreases.
Abstract:
Cardiac allografts suffer diastolic dysfunction early post-heart transplantation (HTx) due to ischemic injury, however the natural course of diastology recovery post HTx remains unknown (Tallaj et al., 2007 [1]). We retrospectively reviewed 60 adult HTx patients between 2015 and 2021 at a single site. Invasive hemodynamics and echocardiograms were obtained at 2 weeks and 1, 3, 6, and 12 months post-HTx. RA strain by 2D feature tracking was compared to intracardiac pressure measurements. In all patients, we observed normalization of RV and RA filling pressures by post-operative week 12 and recovery of diastolic dysfunction by month 6. There was an inverse correlation between RV end-diastolic pressure and RA contractile (r = -0.192, p < 0.05) and reservoir (r = -0.128, p < 0.05) functions in the allograft. As the post-transplant care paradigm shifts away from invasive procedures, right atrial indices should be included in imaging-based allograft surveillance studies.
