title: Longitudinal Strain and Strain Rate Abnormalities Precede Invasive Diagnosis of Transplant Coronary Artery Vasculopathy in Pediatric Cardiac Transplant Patients.
abstract: Transplant coronary artery vasculopathy (TCAV) is the primary cause of late graft loss in pediatric heart transplant recipients. TCAV is diagnosed using angiography or intravascular ultrasound; however, noninvasive methods remain elusive. We sought to define patterns of myocardial mechanics in patients with TCAV and to determine whether this can detect TCAV before invasive methods. In this retrospective study, we queried our heart transplant database to identify all recipients with TCAV since 2006 (n = 41). Echoes were reviewed from the last normal catheterization and at TCAV diagnosis, and from time-matched transplant controls (n = 33) without TCAV. Peak global circumferential and longitudinal strain and systolic and diastolic strain rate (SSR and DSR) of the left ventricle were derived using velocity vector imaging. T tests were used to compare both groups longitudinally and between groups at both time points. Longitudinal strain, SSR, and DSR were diminished in the TCAV group compared to the transplant control group at both time points. No differences were found across time points in either group. Retrospective modeling using a longitudinal strain cutoff of 15 % on echoes 2 years prior to TCAV diagnosis predicted development or exclusion of TCAV with sensitivity of 53 %, specificity of 89 % with an area under the curve of 0.8. Decreases in longitudinal strain measurements demonstrate that alterations in myocardial mechanics occur in patients with TCAV at least 2 years prior to invasive diagnosis. These early changes may be due to microvascular disease. This modality could aid in earlier treatment and intervention for this challenging problem .
authors.affiliation: Division of Cardiology, St. Louis Children's Hospital, 1 Children's Place, Campus Box 8116-NWT, St. Louis, MO, 63110, USA. bridgetzoeller@gmail.com.
authors.forename: Bridget B
authors.initials: BB
authors.lastname: Zoeller
authors.affiliation: Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Miyamoto
authors.affiliation: Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Adel K
authors.initials: AK
authors.lastname: Younoszai
authors.affiliation: Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Landeck
mesh_terms: D000293:Adolescent; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000503:physiopathology*; D016208:Databases, Factual; D003971:Diastole; D004452:Echocardiography; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013318:Stroke Volume; D013599:Systole; D014652:Vascular Diseases / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left
keywords: Longitudinal strain; Myocardial mechanics; Transplant coronary artery vasculopathy
references.citation: J Heart Lung Transplant. 2009 Apr;28(4):320-7
references.pmid: 19332257
references.citation: Br Heart J. 1981 Mar;45(3):248-63
references.pmid: 7008815
references.citation: Tex Heart Inst J. 1995;22(2):138-44
references.pmid: 7647597
references.citation: Curr Cardiol Rev. 2009 May;5(2):133-48
references.pmid: 20436854
references.citation: Circulation. 1992 Mar;85(3):979-87
references.pmid: 1537134
references.citation: Curr Opin Cardiol. 2007 Mar;22(2):139-45
references.pmid: 17284994
references.citation: J Heart Lung Transplant. 2009 Jun;28(6):579-84
references.pmid: 19481018
references.citation: J Heart Lung Transplant. 1992 May-Jun;11(3 Pt 2):S38-44
references.pmid: 1622997
references.citation: Chest. 1995 Sep;108(3):695-700
references.pmid: 7656618
references.citation: Clin Transplant. 2011 Mar-Apr;25(2):175-84
references.pmid: 21457328
references.citation: J Heart Lung Transplant. 2000 Mar;19(3):240-8
references.pmid: 10713248
references.citation: Prog Pediatr Cardiol. 2000 Jun 1;11(2):137-143
references.pmid: 10856695
references.citation: J Thorac Cardiovasc Surg. 2000 May;119(5):1053-77
references.pmid: 10788831
references.citation: J Pediatr. 1990 Feb;116(2):177-83
references.pmid: 2299487
references.citation: J Am Soc Echocardiogr. 2006 Dec;19(12 ):1413-30
references.pmid: 17138024
references.citation: J Heart Lung Transplant. 2012 May;31(5):517-23
references.pmid: 22301421
references.citation: Chest. 2000 Dec;118(6):1792-800
references.pmid: 11115475
references.citation: Paediatr Drugs. 2003;5(8):513-24
references.pmid: 12895134
references.citation: Pediatr Cardiol. 2008 Jan;29(1):19-23
references.pmid: 17891435
references.citation: Pediatr Cardiol. 2012 Jun;33(5):749-56
references.pmid: 22367550
references.citation: J Heart Lung Transplant. 2003 Jan;22(1):44-9
references.pmid: 12531412