The use of Doppler tissue imaging to predict cellular and antibody‐mediated rejection in pediatric heart transplant recipients

Abstract

DTI indices have been associated with cellular rejection in adult heart transplant recipients, but their predictive value in pediatric recipients is unknown. The purpose of this study was to evaluate DTI measures in the detection of cellular and AMR in pediatric heart transplant recipients. One hundred and forty-eight pediatric heart transplant recipients who had 267 cardiac catheterization procedures with EMB, echocardiogram with DTI, and BNP level performed on the same day were included in the study. For the mitral and tricuspid valves, the ratios (E/E') between the early diastolic inflow velocity by pulsed Doppler (E, m/s) and the early diastolic annular velocity by DTI (E', m/s) were obtained and compared between subjects with and without rejection. Of the 148 recipients, 30 subjects had a total of 37 episodes of rejection: 10 cellular (>or=1B), 17 AMR, and 10 biopsy-negative clinical rejection. Mitral and tricuspid valve E/E' ratios were significantly higher in rejectors than in non-rejectors (5.5 +/- 1.3 vs. 4.4 +/- 1.4, p < 0.001 and 4.9 +/- 2.1 vs. 4.1 +/- 1.5, p < 0.01, respectively). By multivariate linear regression, mitral valve E/E' was an independent predictor of rejection. Mitral and tricuspid valve E/E' <5.0 had 93% and 89% NPV, respectively, for rejection. Mitral and tricuspid valve E/E' ratios <5.0 may be useful non-invasive screening measures to exclude rejection in pediatric heart transplant recipients.

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

“…In the present study, we also did not find any association of lateral mitral E/E' or septal E/E' with rejection and these ratios did not correlate with PCWP. Right ventricular end-diastolic pressure has been reported to be elevated in patients with rejection [2]. However, this was not the case in our study.…”

“…In this study mitral E' had no relation to severity of rejection. Another study found a weak correlation between lateral mitral E/E' ratio and PCWP, but an elevated PCWP and mitral and tricuspid E/E' ratios were significantly associated with rejection [2]. Furthermore, the mitral and tricuspid E/E' \ 5.0 had 93 and 89% negative predictive value, respectively for rejection and were proposed to be useful noninvasive screening measures to exclude rejection.…”

Evaluation of the myocardial performance index and tissue doppler imaging by comparison to near-simultaneous catheter measurements in pediatric cardiac transplant patients

“…19 In children who have undergone cardiac transplantation, one study revealed that mitral valve E/E' ratio weakly correlated with pulmonary capillary wedge pressure in subjects with rejection compared with subjects without rejection (r ϭ 0.63, R 2 ϭ 0.4). 20 In contrast, in our study, LV E:E' did not correlate with any of the 3 hemodynamic measurements evaluated (RAp, PAWp and CI). We found a weak correlation between RV E:E' and both right atrial pressure and pulmonary artery wedge pressure.…”

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

“…In our study, neither left nor right heart ventricular filling pressures assessed as PWCP and RAP, respectively, were adequately predicted by Doppler‐based indices, using either the E/E′ ratio or its Z ‐score for LV or the standard E/E′ ratio for RV. Why these indices work less well in children than in adults and so poorly in pediatric heart recipients have been speculated previously . Potential explanations include faster heart rates in children, particularly in denervated hearts of HT recipients, donor‐recipient age mismatch.…”