title: Usefulness of Diastolic Strain Measurements in Predicting Elevated Left Ventricular Filling Pressure and Risk of Rejection or Coronary Artery Vasculopathy in Pediatric Heart Transplant Recipients.
abstract: In pediatric heart transplant recipients, elevated pulmonary capillary wedge pressure (PCWP) is associated with rejection and coronary artery vasculopathy. This study aimed to evaluate which echocardiographic parameters track changes in PCWP and predict adverse outcomes (rejection or coronary artery vasculopathy). This prospective single-center study enrolled 49 patients (median 11.4 years old, interquartile range 7.4 to 16.5) at time of cardiac catheterization and echocardiography. Median follow-up was 2.4 years (range 1.2 to 3.1 years), with serial testing per clinical protocol. Ratio of early mitral inflow to annular velocity (E/E'), left atrial (LA) distensibility, peak LA systolic strain, E/left ventricular (LV) diastolic strain, and E/LV diastolic strain rate were measured from echocardiograms. Increase in PCWP ≥3 mm Hg was associated with changes in LA distensibility, E/E', and E/LV diastolic strain, with highest area under the receiver operating characteristic curve for E/LV diastolic strain (0.76). In 9 patients who subsequently developed rejection or coronary artery vasculopathy, E/LV diastolic strain rate at baseline differed from patients without events (median 57.0 vs 43.6, p = 0.02). On serial studies, only change in LV ejection fraction differed in patients with events (median -10% vs -1%, p = 0.01); decrease in LV ejection fraction of -19% had a specificity of 100% and sensitivity of 44%. In conclusion, LV diastolic strain and strain rate measurements can track changes in PCWP and identify patients at risk for subsequent rejection or coronary artery vasculopathy. Further studies are necessary to confirm these data in a larger cohort.
authors.affiliation: Division of Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan. Electronic address: jimmyL@umich.edu.
authors.forename: Jimmy C
authors.initials: JC
authors.lastname: Lu
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: H Sonali
authors.initials: HS
authors.lastname: Magdo
authors.affiliation: Division of Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Division of Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ray
authors.initials: R
authors.lastname: Lowery
authors.affiliation: Division of Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Aiyagari
authors.affiliation: Division of Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mary
authors.initials: M
authors.lastname: Zamberlan
authors.affiliation: Division of Cardiology, Department of Pediatrics, Ohio State University, Columbus, Ohio.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gajarski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology