Left ventricular myocardial response to exercise in children after heart transplant

Cifra, Barbara; Dragulescu, Andréea; Brun, Henrik; Slorach, Cameron; Friedberg, Mark K.; Manlhiot, Cedric; McCrindle, Brian W.; Dipchand, Anne I.; Mertens, Luc

doi:10.1016/j.healun.2014.07.011

Cited by 29 publications

(34 citation statements)

References 25 publications

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“…Several echocardiographic markers of diastolic function were abnormal, as has been reported previously. 6,28,29 Circumferential strain was elevated in the patients as compared to controls. Whether this observation is merely a reflection of the higher heart rates in HTx patients, is unclear, but heart rate dependencies of tissue Doppler measurements are well known, including in children after HTx.…”

Section: Discussionmentioning

confidence: 85%

“…Whether this observation is merely a reflection of the higher heart rates in HTx patients, is unclear, but heart rate dependencies of tissue Doppler measurements are well known, including in children after HTx. 28,30,31 Native T1 times correlated with the LV E/e' ratio by echocardiography as a marker of diastolic dysfunction and surrogate of elevated LV filling pressures. This association is in line with the reported association between histological myocardial fibrosis and restrictive physiology in patients who underwent retransplantation.…”

Section: Discussionmentioning

confidence: 94%

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Diffuse Myocardial Fibrosis in Children After Heart Transplantations

et al. 2015

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 94%

Diffuse Myocardial Fibrosis in Children After Heart Transplantations

et al. 2015

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“…Twenty‐nine articles underwent full‐text review, with an additional 13 articles excluded due to participant age (n=7), lack of exercise testing (n=3), and articles not in English (n=3). A total of 16 studies were included in this systematic review: six prospective cross‐sectional, five retrospective longitudinal, four retrospective cross‐sectional, and one case series . Validity appraisal scores ranged from 6/9 to 8/9.…”

Section: Resultsmentioning

confidence: 99%

Exercise capacity following pediatric heart transplantation: A systematic review

Peterson

Szmuszkovicz

et al. 2017

Pediatric Transplantation

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Pediatric HTs account for 13% of all HTs with >60% of recipients surviving at least 10 years post-HT. The purpose of this systematic review is to synthesize the literature on exercise capacity of pediatric HT recipients to improve understanding of the mechanisms that may explain the decreased exercise capacity. Six databases were searched for studies that compared the exercise capacity of HT recipients ≤21 years old with a control group or normative data. Sixteen studies were included. Pediatric HT recipients, as compared to controls or normative data, exhibit significantly higher resting HR, and at peak exercise exhibit significantly decreased HR, VO , power, work, minute ventilation, and exercise duration. Peak VO appears to improve within the first 2.5 years post-HT; peak work remains constant; and there is inconclusive evidence that peak HR, HR recovery, and HR reserve improve with time since HT. These results are discussed in the context of the mechanisms that may explain the impaired exercise capacity of pediatric HT recipients, including chronotropic incompetence, graft dysfunction, side effects of immunosuppression therapy, and deconditioning. In addition, the limited literature on rehabilitation after pediatric HT is summarized.

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“…Patients had larger LV mass and increased mass-to-volume ratio, the latter suggesting that the increased LV mass is not merely the result of larger graft organs and a donor-recipient mismatch. Another possibility is that the increased LV ‘mass’ by CMR is a reflection of edema, rather than myocyte hypertrophy [1–5, 27]. However, cases with ACR 2R at the time of CMR did not have higher LV mass or mass-to-volume ratio as compared to controls.…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial strain has been proposed as a sensitive marker of subclinical changes in myocardial performance in a variety of conditions; abnormalities in strain often precede a decline in EF [27, 28]. Miller and colleagues witnessed an association of reduced circumferential strain by CMR tagging in adult HTX recipients with clinically significant ACR (grade 2 R or higher) [26].…”

Section: Discussionmentioning

confidence: 99%

Abnormal Myocardial Contractility After Pediatric Heart Transplantation by Cardiac MRI

et al. 2017

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Acute cellular rejection (ACR) compromises graft function after heart transplantation (HTX). The purpose of this study was to describe systolic myocardial deformation in pediatric HTX and to determine whether it is impaired during ACR. Eighteen combined cardiac magnetic resonance imaging (CMR)/endomyocardial biopsy (EMBx) examinations were performed in 14 HTX patients (11 male, age 13.9 ± 4.7 years; 1.2 ± 1.3 years after HTX). Biventricular function and left ventricular (LV) circumferential strain, rotation, and torsion by myocardial tagging CMR were compared to 11 controls as well as between patients with and without clinically significant ACR. HTX patients showed mildly reduced biventricular systolic function when compared to controls [LV ejection fraction (EF): 55 ± 8% vs. 61 ± 3, p = 0.02; right ventricular (RV) EF: 48 ± 7% vs. 53 ± 6, p = 0.04]. Indexed LV mass was mildly increased in HTX patients (67 ± 14 g/m2 vs. 55 ± 13, p = 0.03). LV myocardial deformation indices were all significantly reduced, expressed by global circumferential strain (−13.5 ± 2.3% vs. −19.1 ± 1.1%, p < 0.01), basal strain (−13.7 ± 3.0% vs. −17.5 ± 2.4%, p < 0.01), mid-ventricular strain (−13.4 ± 2.7% vs. −19.3 ± 2.2%, p < 0.01), apical strain (−13.5 ± 2.8% vs. −19.9 ± 2.0%, p < 0.01), basal rotation (−2.0 ± 2.1° vs. −5.0 ± 2.0°, p < 0.01), and torsion (6.1 ± 1.7° vs. 7.8 ± 1.1°, p < 0.01). EMBx demonstrated ACR grade 0 R in 3 HTX cases, ACR grade 1 R in 11 HTX cases and ACR grade 2 R in 4 HTX cases. When comparing clinically non-significant ACR (grades 0–1 R vs. ACR 2 R), basal rotation, and apical rotation were worse in ACR 2 R patients (−1.4 ± 1.8° vs. −4.2 ± 1.4°, p = 0.01 and 10.2 ± 2.9° vs. 2.8 ± 1.9°, p < 0.01, respectively). Pediatric HTX recipients demonstrate reduced biventricular systolic function and decreased myocardial contractility. Myocardial deformation indices by CMR may serve as non-invasive markers of graft function and, perhaps, rejection in pediatric HTX patients.

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Left ventricular myocardial response to exercise in children after heart transplant

Cited by 29 publications

References 25 publications

Diffuse Myocardial Fibrosis in Children After Heart Transplantations

Diffuse Myocardial Fibrosis in Children After Heart Transplantations

Exercise capacity following pediatric heart transplantation: A systematic review

Abnormal Myocardial Contractility After Pediatric Heart Transplantation by Cardiac MRI

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