Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation

Ingvarsson, Annika; Evaldsson, Anna Werther; Waktare, Johan; Nilsson, Johan; Smith, Gudmund J. W.; Stagmo, Martin; Roijer, Anders; Rådegran, Göran; Meurling, Carl

doi:10.1016/j.echo.2017.11.003

Cited by 47 publications

(79 citation statements)

References 45 publications

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“…RAF was significantly decreased in our PHTx population regardless of comorbidities compared to normal controls, consistent with suggested signs of baseline diastolic dysfunction of transplanted hearts that has been previously reported by others . RAF has been studied in adults with the bi‐caval technique showing a marked decrease in atrial reservoir function compared to controls as seen in our population .…”

Section: Discussionsupporting

confidence: 92%

Right atrial function in pediatric heart transplant patients by echocardiographic strain measurements

Watanabe

Schäfer

Cassidy

et al. 2019

Pediatric Transplantation

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Background CAV is a major cause of mortality in PHTx patients. Research on echocardiographic indices to detect CAV focuses primarily on ventricular function and less is known about RAF. Thus, we primarily sought to evaluate RAF in PHTx patients with CAV. For secondary analysis, we compared RAF between PHTx patients and control patients and evaluated RAF with respect to rejection and surgical type. Methods We retrospectively evaluated echocardiography derived RA strain indices in recipients <18 years old and >1 year from time of transplant. The RA strain phases included, reservoir (εs), conduit (εe), pump (εa), and respective strain rate indices (SRs, SRe, SRa). Results There were 36 PHTx patients and 14 age‐, sex‐matched control patients. There was a significant reduction in εs, εe, SRs, and SRe (P < 0.001) in the PHTx patients when compared to controls. There was no difference between the CAV (+) and CAV (−) patients with respect to RAF indices. Furthermore, εs, εe, and SRe (P < 0.05) were lower in patients with acute rejection (n = 7) compared to those without (n = 26). Patients with a bi‐atrial anastomosis (n = 14) had decreased εs, εa, SRs, SRa (P < 0.05), compared to bi‐caval anastomosis (n = 24). Conclusion PHTx patients have decreased RAF compared to healthy children. RAF does not differentiate PHTx patients based on the presence of CAV. RAF is also decreased in PHTx patients with rejection and in those transplanted with a bi‐atrial anastomosis.

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Section: Discussionsupporting

confidence: 92%

Right atrial function in pediatric heart transplant patients by echocardiographic strain measurements

Watanabe

Schäfer

Cassidy

et al. 2019

Pediatric Transplantation

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“…Patients operated with biatrial technique had significantly larger atria than the bicaval group independent of gender. This is consistent with previously published data and with the nature of the respective operative technique (Ingvarsson et al ., ).…”

Section: Discussionmentioning

confidence: 97%

“…We found mean EF to be within normal range for both genders as previously described (Syeda et al ., ; Ingvarsson et al ., ). Concerning recipient gender, women (regardless of donor gender) had slightly higher mean EF than males, which is in agreement with previous findings and current guidelines regarding healthy subjects (Maffessanti et al ., ; Lang et al ., ).…”

Section: Discussionmentioning

confidence: 97%

“…Previous rejection has been described to negatively impact LVGLS and EF (Marciniak et al ., ; Ingvarsson et al ., ). We found no differences in ventricular function parameters related to previous treatment requiring rejection when comparing patients within gender groups or when comparing sex‐matched and non‐sex‐matched recipient.…”

Section: Discussionmentioning

confidence: 97%

“…The reduction in longitudinal strain seen in HTx patients has been previously described (Eleid et al ., ; Saleh et al ., ; Syeda et al ., ; Buddhe et al ., ; Ingvarsson et al ., ), but to our knowledge it has never been studied in relation to gender. In this study, both LV and RV longitudinal strain were significantly higher in female than in male recipients.…”

Section: Discussionmentioning

confidence: 98%

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Impact of gender on echocardiographic characteristics in heart transplant recipients

Ingvarsson

Werther-Evaldsson

Smith

et al. 2019

Clin Physio Funct Imaging

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Summary Aims Assessment following heart transplantation (HTx) is routinely performed using transthoracic echocardiography. Differences in long‐term mortality following HTx related to donor‐recipient matching have been reported, but effects of gender on cardiac size and function are not well studied. The aims of this study were to evaluate differences in echocardiographic characteristics of HTx recipients defined by gender. Methods and results The study prospectively enrolled 123 (n = 34 female) HTx recipients of which 23 recipients was donor‐recipient gender mismatched. Patients were examined with 2‐dimensional echocardiography using Philips iE33 ultrasound system. Data were analysed across strata based on recipient gender and gender mismatch. Male recipients had larger left ventricular (LV) mass, thicker septal wall (P<0·001) and larger absolute LV volumes (P<0·001). Mean LV ejection fraction (EF) was higher in females (P<0·05), but no differences in conventional parameters of right ventricular (RV) function were found. Ventricular strain was higher in females than in males: LV global longitudinal strain (P<0·01), RV global longitudinal strain (P<0·05) and RV lateral free wall (P<0·05). The male group receiving a female donor heart had comparable EF and strain parameters to the female group receiving a gender‐matched heart. Conclusion We found that female recipient gender was associated with smaller chamber size, higher LV EF and better LV and RV longitudinal strain. Gender‐mismatched male recipients appeared to exhibit function parameters similar to gender‐matched female recipients. Our results indicate that the gender aspect, analogous to current reference guidelines in general population, should be taken into consideration when examining patients post‐HTx.

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Echocardiographic assessment of radial right ventricular function in heart transplant recipients

et al. 2021

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Aims Right ventricular (RV) allograft dysfunction is present in half of all heart transplant (HT) recipients. Non‐invasive assessment of RV function in the setting of rejection is not well described. We outline an echocardiographic technique, short‐axis fractional area change (SAXFAC), to evaluate RV function in the HT population and correlate this with the grade of pathologic rejection. Methods and results We retrospectively reviewed the electronic medical records of 110 people who received a HT between 1 January 2015 and 29 February 2020 and had no evidence of rejection. One hundred eighty‐two transthoracic echocardiograms (TTEs) completed up to 1 year from the date of transplantation were analysed for the target acoustic window, the parasternal mid‐ventricular short‐axis view. Sixty‐one TTEs from 23 healthy transplants were deemed appropriate for SAXFAC determination. Thirty‐three organ recipients with at least grade 1R allograft rejection were also identified, and their TTEs screened for SAXFAC analysis. Two expert readers independently calculated SAXFAC as follows: RV end‐diastolic area minus end‐systolic area divided by end‐diastolic area. Using commercially available software (Epsilon, Ann Arbor, Michigan), we quantified RV radial strain, longitudinal strain, and apical fractional area change (FAC). Twenty‐eight transplant recipients with grade 0R or 1R rejection and nine patients with clinically significant rejection completed the study analysis. SAXFAC demonstrated significant variability in the entire population with an inverse relationship to severity of allograft rejection (P ≤ 0.01). Radial strain and FAC were also associated with clinically significant rejection (P ≤ 0.01). Conclusions Short‐axis fractional area change is a simple two‐dimensional technique to assess RV function in HT recipients and showed no significant inter‐observer variability. In our small, single‐centre, retrospective case series, lower SAXFAC values were associated with clinically significant allograft rejection. The small sample size and infrequent occurrence of rejection make our observations hypothesis‐generating only. We advocate dedicated RV SAXFAC imaging planes be included when assessing allograft function.

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Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation

Cited by 47 publications

References 45 publications

Right atrial function in pediatric heart transplant patients by echocardiographic strain measurements

Right atrial function in pediatric heart transplant patients by echocardiographic strain measurements

Impact of gender on echocardiographic characteristics in heart transplant recipients

Echocardiographic assessment of radial right ventricular function in heart transplant recipients

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