Doppler tissue imaging and catheter-derived measures are not independent predictors of rejection in pediatric heart transplant recipients

Sachdeva, Ritu; Malik, Sadia; Seib, Paul M.; Frazier, Elizabeth A.; Cleves, Mario A.

doi:10.1007/s10554-010-9747-4

Cited by 22 publications

(14 citation statements)

References 21 publications

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“…Other cross-sectional studies in children who were rejection-free at the time of their PW-TDI imaging but had previous rejection history have also documented abnormal tissue velocities compared with controls. 19,20 Our study expands the current knowledge-base by analyzing a larger cohort of HT recipients in a longitudinal study design, following study subjects for a longer duration, transforming raw TDI velocities into age-adjusted z scores and analyzing serial invasive hemodynamic studies performed along a similar time line. Furthermore, although some of the findings of our analysis could be anticipated from previous reports, our analysis provides a broad and integrated view of longitudinal changes in graft function in the contemporary RV dysfunction is an important determinant of early post-HT outcomes.…”

Section: Discussionmentioning

confidence: 98%

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Lunze

Colan

Gauvreau

et al. 2012

Circ: Cardiovascular Imaging

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Background-Allograft dysfunction is a common finding early after heart transplant (HT). We sought to assess the recovery of left (LV) and right ventricular (RV) function during the first year after HT in children and young adults using pulsedwave tissue Doppler imaging. Methods and Results-We analyzed serially performed echocardiography in 44 pediatric HT recipients (median age: 7.3 years at HT) who remained rejection-free during the first year post-transplant. Age-based normative values for systolic (S′), early-diastolic (E′), and late-diastolic (A′) velocities obtained using pulsed-wave tissue Doppler imaging in 380 healthy children were used to transform patient data into z scores. Pulsed-wave tissue Doppler imaging studies ≤10 days post-HT demonstrated biventricular systolic and diastolic dysfunction with most prominent impairment in RV systolic function (S′ z score −2.7±0.8), RV early-diastolic filling (E′ z score −2.3±1.1), and LV early-diastolic filling (E′ z score −2.3±1.1). LV systolic function (S′ z score) and late-diastolic filling (A′ z score) improved to normal in 11 to 30 days, LV early-diastolic filling (E′ z score) in 4 to 6 months, and RV early-diastolic filling in 6 to 9 months (P<0.001 for all on longitudinal analysis). However, RV systolic function (RV S′ z score −1.2±1.1) remained impaired 1-year post-transplant. Analysis of serial cardiac catheterization studies showed that RV and LV filling pressures were elevated early post-HT and declined gradually during the first year post-transplant. Conclusions-Pediatric

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Section: Discussionmentioning

confidence: 98%

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Lunze

Colan

Gauvreau

et al. 2012

Circ: Cardiovascular Imaging

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“…87 Echocardiogramderived Doppler tissue imaging as a measure of diastolic function has been reported to be an independent predictor of AMR in pediatric heart transplant recipients, although this was not supported by Sachdeva and colleagues. 88 Although diastolic indices can be abnormal in acute rejection in adult heart transplant recipients, the sensitivity and specificity are low. 88,89 Novel methods such as nuclear perfusion and cardiac magnetic resonance imaging may have an evolving role, especially in detecting myocardial edema and increased LV mass.…”

Section: Assessment Of Amr Imaging Modalitiesmentioning

confidence: 99%

“…88 Although diastolic indices can be abnormal in acute rejection in adult heart transplant recipients, the sensitivity and specificity are low. 88,89 Novel methods such as nuclear perfusion and cardiac magnetic resonance imaging may have an evolving role, especially in detecting myocardial edema and increased LV mass. [90][91][92][93][94][95][96][97] One of the most promising cardiac magnetic resonance imaging modalities is T2 quantification.…”

Section: Assessment Of Amr Imaging Modalitiesmentioning

confidence: 99%

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

283

251

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“…The relationship of LV E/E′ ratio to LV filling pressure has been investigated in several studies of pediatric heart recipients . None of them have found the association of LV E/E′ ratio with LV filling pressures to be robust whether obtained simultaneously, immediately after, within four hours of heart catheterization procedure or whether assessed as PCWP and/or LV end‐diastolic pressure .…”

Section: Discussionmentioning

confidence: 99%

Is Doppler echocardiography useful for estimating left ventricular filling pressures in pediatric heart transplant recipients?

Lunze

Narciso

Blume

et al. 2019

Pediatric Transplantation

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LV E/E′ ratio obtained using Doppler echocardiography is considered a surrogate for LV filling pressure in adults but has performed poorly in children. We hypothesized that LV E/E′ ratio Z‐score, adjusted for age, will relate more strongly to LV filling pressures than LV E/E′ ratio in pediatric HT recipients. We analyzed 751 echocardiograms performed within 24 hours of a heart catheterization in 122 pediatric HT recipients (median age at HT 13 years, median 6 studies per patient). The primary end‐point was PCWP, assessed both as a continuous and a binary variable. Associations with LV E/E′ ratios and z‐scores were assessed using generalized estimating equations models. PCWP, LV E/E′ ratios (using E′ from LV free wall, septum, and their average), and LV E/E′ ratio Z‐scores, all declined over time after HT. LV E/E′ ratios and their Z‐scores were significantly associated with PCWP assessed as a continuous variable (P < 0.001 for all); however, the relationship was weak (R2 range, 0.083 to 0.121). LV E/E′ ratios and their Z‐scores were also significantly associated with PCWP as a binary variable (P < 0.001 for all) but with only modest ability to discriminate PCWP ≥15 mm Hg (c‐statistic range, 0.660 to 0.695). The association between LV E/E′ ratio and PCWP in pediatric HT recipients is modest. Using a LV E/E′ ratio Z‐score did not result in significantly improved association with PCWP. Current Doppler echocardiographic methods are unreliable for estimating LV filling pressures in pediatric HT recipients.

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Doppler tissue imaging and catheter-derived measures are not independent predictors of rejection in pediatric heart transplant recipients

Cited by 22 publications

References 21 publications

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Is Doppler echocardiography useful for estimating left ventricular filling pressures in pediatric heart transplant recipients?

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