title: Echocardiography detects elevated left ventricular filling pressures in heart transplant recipients.
abstract: Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E' lateral) parameters, and the Doppler-estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E' lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography.
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Odd
authors.initials: O
authors.lastname: Bech-Hanssen
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Habeeb
authors.forename: Waqas
authors.initials: W
authors.lastname: Ahmed
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Salvo
authors.forename: Valeria
authors.initials: V
authors.lastname: Pergola
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Admawi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Amri
authors.forename: Maie
authors.initials: M
authors.lastname: Al-Shahid
authors.forename: Jehad
authors.initials: J
authors.lastname: Al-Buraiki
authors.forename: Bahaa M
authors.initials: BM
authors.lastname: Fadel
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: diastolic dysfunction; echocardiography; heart transplant recipient