title: Doppler tissue imaging in children following cardiac transplantation: a comparison to catheter derived hemodynamics.
abstract: Previous studies have demonstrated a correlation between E:E(a) and ventricular filling pressure in adults after heart transplantation. We sought to determine if E:E(a) correlates with filling pressure after heart transplantation in children. A prospective analysis of children who have undergone heart transplantation was performed. Inflow and myocardial velocities were recorded and compared to catheter-derived filling pressures and rejection status. We performed 61 studies in 49 subjects. No correlation was found between septal E:E(a) and PCWP (r=0.14, p=0.28); or between lateral tricuspid E:E(a) and mean RAp (r=0.04, p=0.79). However, the mean PCWP was higher among subjects with elevated septal E:E(a) (>12) compared to normal E:E(a) (12.3±2.8mmHg vs. 10.1±2.9mmHg, p=0.02). Similarly, mean RAp was higher among subjects with an elevated lateral tricuspid E:E(a) (>10) compared to normal lateral tricuspid E:E(a) (7.7±2.1mmHg vs. 6.0±2.4mmHg, p=0.04). Elevated septal E:E(a) was also associated with high-grade cellular rejection (OR=17.3 [95% CI 1.4-221], p=0.028). In children following heart transplant, E:E(a) does not correlate well with the range of filling pressures seen after pediatric heart transplantation. However, a septal E:E(a)>12 is associated with elevated PCWP and high grade cellular rejection and a lateral tricuspid E:E(a)>10 is associated with elevated mean RAp.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. goldbergda@email.chop.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Michael D
authors.initials: MD
authors.lastname: Quartermain
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Hall
authors.forename: Erin
authors.initials: E
authors.lastname: Davis
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Kren
authors.forename: Brian D
authors.initials: BD
authors.lastname: Hanna
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D016027:Heart Transplantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000473:pathology; D011446:Prospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods*