title: Association of pediatric heart transplant coronary vasculopathy with abnormal hemodynamic measures.
abstract: OBJECTIVE
  Transplant coronary artery disease (TCAD) is the limiting factor to long-term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter-derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients. DESIGN, PATIENTS, OUTCOME MEASURES: Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheter-derived right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.
  
  
  RESULTS
  TCAD was diagnosed an average of 8.3 years post-HTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheter-derived pressure measurements showed that RVEDP was elevated in TCAD compared with non-TCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10 mm Hg or PCWP > 12 mm Hg was associated with TCAD (OR = 5.2; P= .010).
  
  
  CONCLUSIONS
  In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.
authors.affiliation: C.S. Mott Children's Hospital, Division of Pediatric Cardiology, University of Michigan Health Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. ranjita@med.umich.edu
authors.forename: Ranjit
authors.initials: R
authors.lastname: Aiyagari
authors.forename: Melisa
authors.initials: M
authors.lastname: Nika
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.forename: Mary C
authors.initials: MC
authors.lastname: Zamberlan
authors.forename: Karen
authors.initials: K
authors.lastname: King
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Crowley
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gajarski
mesh_terms: D000293:Adolescent; D001706:Biopsy; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008824:Michigan; D011669:Pulmonary Wedge Pressure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure; D055815:Young Adult