title: Restrictive hemodynamics are present at the time of diagnosis of allograft coronary artery disease in children.
abstract: Clinical recognition of allograft coronary artery disease (ACAD) is challenging. We examined whether right heart hemodynamics can aid its diagnosis in pediatric recipients. We retrospective analyzed hemodynamic data of recipients with ACAD versus age and date-of-transplant matched controls. From 1982-2001, 18 cases fulfilled study entry criteria. Median age at transplant was 12 years for subjects and 8 years for controls. Median time to diagnosis of ACAD was 65 months (14.5-124 months) and 67 months (16-140 months) to arteriography for controls. The median right ventricular end-diastolic pressure (RVEDP) at diagnosis was 11.0 vs. 6.0 mmHg for controls (p = 0.003). Pulmonary capillary wedge pressure (PCWP) at diagnosis was 14.0 vs. 8.0 mmHg for controls (p = 0.001). When subdivided by severity of ACAD, the difference was greater in the moderate/severe group. Compared to the previous catheterization (median interval 10 months for subjects, 12.0 for controls ), there was an increase of 4.0 mmHg in RVEDP in ACAD subjects (n = 13, p = .003) versus 0 mmHg in controls (p = 0.042), and an increase in PCWP of 5.5 in subjects (p = .002) versus 0 mmHg in controls (p = 0.066). The presence of elevated filling pressures plus an interim increase should alert to the presence of ACAD and help guide further investigation.
authors.affiliation: Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, OR, USA. lawy@ohsu.edu
authors.forename: Yuk
authors.initials: Y
authors.lastname: Law
authors.forename: Gerard
authors.initials: G
authors.lastname: Boyle
authors.forename: Susan
authors.initials: S
authors.lastname: Miller
authors.forename: James
authors.initials: J
authors.lastname: Clendaniel
authors.forename: Jose
authors.initials: J
authors.lastname: Ettedgui
authors.forename: Lee
authors.initials: L
authors.lastname: Beerman
authors.forename: Peter
authors.initials: P
authors.lastname: Counihan
authors.forename: Steven
authors.initials: S
authors.lastname: Webber
mesh_terms: D016280:Atrial Function, Right; D002648:Child; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D016027:Heart Transplantation; D006801:Humans; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016278:Ventricular Function, Right