Noninvasive Predictors of Diastolic Dysfunction in Children after Cardiac Transplant

DiPietro, Amy; Sexson-Tejtel, S. Kristen; Pignatelli, Ricardo H.; Cui, Qiqiong; Cabrera, Antonio G.; Price, Jack F.; Mitchell, D.; Dreyer, William J.; Jeewa, Aamir; Denfield, Susan W.

doi:10.1016/j.healun.2013.01.463

Cited by 2 publications

(5 citation statements)

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“…It is unclear if this reflects a limitation in the ability of T1 values to assess for myocardial fibrosis burden; however, it is more likely that fibrosis percentage measurements from randomly sampled EMB tissue samples do not accurately reflect whole heart myocardial fibrosis burden. Non-invasive markers, such as BNP and echocardiography mitral E/e’, have also been shown to correlate with RVEDP and pulmonary capillary wedge pressure [ 52 ], markers of graft dysfunction. Though native T1 values showed moderate correlation with hemodynamic markers and BNP when patients in acute clinical rejection were included, this correlation was not found when looking only at patients without rejection.…”

Section: Discussionmentioning

confidence: 99%

Native T1 mapping detects both acute clinical rejection and graft dysfunction in pediatric heart transplant patients

Richmann

Gurijala

Mandell

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Background Cardiovascular magnetic resonance (CMR) is emerging as an important tool for cardiac allograft assessment. Native T1 mapping may add value in identifying rejection and in assessing graft dysfunction and myocardial fibrosis burden. We hypothesized that CMR native T1 values and features of textural analysis of T1 maps would identify acute rejection, and in a secondary analysis, correlate with markers of graft dysfunction, and with fibrosis percentage from endomyocardial biopsy (EMB). Methods Fifty cases with simultaneous EMB, right heart catheterization, and 1.5 T CMR with breath-held T1 mapping via modified Look-Locker inversion recovery (MOLLI) in 8 short-axis slices and subsequent quantification of mean and peak native T1 values, were performed on 24 pediatric subjects. A single mid-ventricular slice was used for image texture analysis using nine gray-level co-occurrence matrix features. Digital quantification of Masson trichrome stained EMB samples established degree of fibrosis. Markers of graft dysfunction, including serum brain natriuretic peptide levels and hemodynamic measurements from echocardiography, catheterization, and CMR were collated. Subjects were divided into three groups based on degree of rejection: acute rejection requiring new therapy, mild rejection requiring increased ongoing therapy, and no rejection with no change in treatment. Statistical analysis included student’s t-test and linear regression. Results Peak and mean T1 values were significantly associated with acute rejection, with a monotonic trend observed with increased grade of rejection. Texture analysis demonstrated greater spatial heterogeneity in T1 values, as demonstrated by energy, entropy, and variance, in cases requiring treatment. Interestingly, 2 subjects who required increased therapy despite low grade EMB results had abnormal peak T1 values. Peak T1 values also correlated with increased BNP, right-sided filling pressures, and capillary wedge pressures. There was no difference in histopathological fibrosis percentage among the 3 groups; histopathological fibrosis did not correlate with T1 values or markers of graft dysfunction. Conclusion In pediatric heart transplant patients, native T1 values identify acute rejection requiring treatment and may identify graft dysfunction. CMR shows promise as an important tool for evaluation of cardiac grafts in children, with T1 imaging outperforming biopsy findings in the assessment of rejection.

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Section: Discussionmentioning

confidence: 99%

Native T1 mapping detects both acute clinical rejection and graft dysfunction in pediatric heart transplant patients

Richmann

Gurijala

Mandell

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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“…In contrast, some pediatric studies have suggested echocardiographic evaluation can predict LVEDp or PCWP. White et al found septal E/e' was the sole predictor of PCWP and DiPietro et al showed a septal E/e′> 10 was associated with an abnormal PCWP 15,16 . A major limitation to both of these studies, however, was echo and catheterization data were collected at different time points and under different loading conditions.…”

Section: Discussionmentioning

confidence: 99%

“…However, age‐related variations in both ventricular compliance and measurements of diastolic function pose significant challenges in the pediatric population 12 . Multiple pediatric echocardiography studies have attempted to predict cardiac catheterization measurements of diastolic function but have only done so at different times and in different hemodynamic states, and have produced inconsistent and contradictory results 13–16 …”

Section: Introductionmentioning

confidence: 99%

“…12 Multiple pediatric echocardiography studies have attempted to predict cardiac catheterization measurements of diastolic function but have only done so at different times and in different hemodynamic states, and have produced inconsistent and contradictory results. [13][14][15][16] Therefore, we assessed the association between echocardiographic derived measurements of diastolic function and simultaneously obtained LVEDP and/or PCWP in the cardiac catheterization laboratory and utilized a fluid bolus to ensure optimal loading conditions for both echocardiographic-and catheterization-derived measurements. During the initial hemodynamic measurements, a baseline transthoracic echocardiogram was performed per study echocardiographic protocol, as below.…”

Section: Introductionmentioning

confidence: 99%

“…7,17 We are aware of only one pediatric study utilizing pre-load alteration to help evaluate diastolic function in the cardiac catheterization lab, but the authors focused on right ventricular hemodynamics, without assessments of LVEDP or PCWP 11. In our cohort, cardiac cathe-e′> 10 was associated with an abnormal PCWP 15,16. A major limitation to both of these studies, however, was echo and catheterization data were collected at different time points and under different loading conditions.…”

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confidence: 98%

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Standard volume infusion unmasked diastolic dysfunction in pediatric heart transplant recipients during surveillance cardiac catheterization, but without echocardiographic correlates

Biddix

Hainstock

Vergales

et al. 2022

Pediatric Transplantation

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Background: Adult experience evaluating left ventricular diastolic function (LVDFx) includes volume administration during catheterization while obtaining pulmonary capillary wedge pressures (PCWP) or left ventricular end diastolic pressures (LVEDP).Catheterization is inherently challenging in pediatric patients, making echocardiographic assessment ideal. Pediatric echocardiographic studies predicting LVDFx have variable hemodynamic and hydration conditions and have produced inconsistent results. We evaluated the association between simultaneous echocardiographic and catheterization assessment of LVDFx, using a fluid bolus for optimal loading conditions. Methods: Prospective cohort study of pediatric heart transplant recipients receiving echocardiogram simultaneous with routine cardiac catheterization. Mitral valve inflow velocities, septal and lateral wall tissue Doppler indices, and PCWP and/or LVEDP were obtained and repeated following a 10 ml/kg bolus. Echocardiographic parameters were evaluated for an association with changes in PCWP or LVEDP following the bolus. Abnormal LVDFx was defined as PCWP or LVEDP ≥12 mm Hg. Results: Twenty-nine patients underwent catheterization. Median pre-bolus PCWP and LVEDP were 11.0 mm Hg and 10.0 mm Hg, respectively. After bolus, median PCWP and LVEDP increased to 14.0 mm Hg (p < .001) and 13 mm Hg (p < .001), respectively. Of 21 patients with normal pre-bolus catheterization hemodynamics, 14 (66.7%) increased to abnormal following fluid bolus. Using area under an ROC, no echocardiographic parameter of LVDFx, or their ratios, were associated with predetermined abnormal LVEDP and/or PCWP. Conclusion: After bolus, our cohort demonstrated significant increases in LVEDP and/or PCWP, unmasking diastolic dysfunction. Fluid challenges should be considered in pediatric patients undergoing cardiac catheterization with suspected diastolic This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Noninvasive Predictors of Diastolic Dysfunction in Children after Cardiac Transplant

Cited by 2 publications

References 0 publications

Native T1 mapping detects both acute clinical rejection and graft dysfunction in pediatric heart transplant patients

Native T1 mapping detects both acute clinical rejection and graft dysfunction in pediatric heart transplant patients

Standard volume infusion unmasked diastolic dysfunction in pediatric heart transplant recipients during surveillance cardiac catheterization, but without echocardiographic correlates

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