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Alfares FA, Nanjegowda C, Swaminathan S, Hunter J, Alkon J, Sandhu S, Rusconi P. Echocardiography to predict left ventricular filling pressure for long-term paediatric heart transplant patients. Cardiol Young 2024:1-6. [PMID: 38706324 DOI: 10.1017/s1047951124000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Left ventricular diastolic dysfunction is a recognised sequela following transplantation in paediatric heart transplant patients. Traditional echocardiographic indices do not correlate well with left ventricular filling pressure immediately after transplantation. This study aimed to assess whether these indices have any long-term correlation after transplantation in paediatric patients. METHODS A retrospective chart review of 41 patients who had a heart transplant before the age of 24 years was performed. The median time since the transplantation was 11 years. Data obtained from surveillance cardiac catheterisation and echocardiographic examination were reviewed. Traditional echocardiographic indices of diastolic function were compared with the pulmonary capillary wedge pressure and left ventricular end-diastolic pressure obtained from cardiac catheterisation. RESULTS The median age at transplant was 12.1 years, and the median time since transplant was 11 years. Eighteen patients (43%) had a history of at least one rejection episode and 12 patients (29%) had a history of cardiac allograft vasculopathy. There was no correlation between mitral inflow E velocity, mitral E/A ratio, tissue Doppler velocities, mitral E/e' (mitral inflow E velocity to mitral annular velocity), and elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. There was no correlation between mitral valve deceleration time or isovolumetric relaxation time with elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. CONCLUSION Our findings suggest that traditional echocardiographic indices of diastolic function do not correlate well with elevated invasive pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure in paediatric heart transplant patients' long-term post-transplantation.
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Affiliation(s)
- Fahad A Alfares
- Pediatric Cardiology Unit, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Chetan Nanjegowda
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Juanita Hunter
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jaime Alkon
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Satinder Sandhu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Paolo Rusconi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
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Rodríguez-Diego S, Ruiz-Ortiz M, Delgado-Ortega M, Kim J, Weinsaft JW, Sánchez-Fernández JJ, Ortega-Salas R, Carnero-Montoro L, Carrasco-Ávalos F, López-Aguilera J, López-Granados A, Arizón del Prado JM, Romo-Peñas E, Pardo-González L, Hidalgo-Lesmes FJ, Álvarez-Ossorio MP, Mesa-Rubio D. The Role of Left Atrial Longitudinal Strain in the Diagnosis of Acute Cellular Rejection in Heart Transplant Recipients. J Clin Med 2022; 11:jcm11174987. [PMID: 36078920 PMCID: PMC9456609 DOI: 10.3390/jcm11174987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
Our aim was to investigate the role of left atrial longitudinal strain (LALS) in the non-invasive diagnosis of acute cellular rejection (ACR) episodes in heart transplant (HTx) recipients. Methods: We performed successive echocardiographic exams in 18 consecutive adult HTx recipients in their first year after HTx within 3 h of the routine surveillance endomyocardial biopsies (EMB) in a single center. LALS parameters were analyzed with two different software. We investigated LALS association with ACR presence, as well as inter-vendor variability in comparable LALS values. Results: A total of 147 pairs of EMB and echo exams were carried out. Lower values of LALS were significantly associated with any grade of ACR presence. Peak atrial longitudinal strain (PALS) offered the best diagnostic value for any grade of ACR, with a C statistic of 0.77 using one software (95% CI 0.68−0.84, p < 0.0005) and 0.64 with the other (95% CI 0.54−0.73, p = 0.013) (p = 0.02 for comparison between both curves). Reproducibility between comparable LALS parameters was poor (intraclass correlation coefficients were 0.60 for PALS, 95% CI 0.42−0.73, p < 0.0005; and 0.42 for PALS rate, 95% CI −0.13−0.68, p < 0.0005). Conclusions: LALS variables might be a sensitive marker of ACR in HTx recipients, principally discriminating between those studies without rejection and those with any grade of ACR. Inter-vendor variability was significant.
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Affiliation(s)
- Sara Rodríguez-Diego
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Correspondence: ; Tel.: +34-957-01-03-29
| | - Martín Ruiz-Ortiz
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | | | - Jiwon Kim
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Jonathan W. Weinsaft
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Rosa Ortega-Salas
- Pathology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | | | | | - José López-Aguilera
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | | | | | - Elías Romo-Peñas
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | | | | | | | - Dolores Mesa-Rubio
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
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Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The three most common modalities of graft surveillance in pediatric heart transplant (HT) recipients include echocardiography, coronary angiography, and endomyocardial biopsy (EMB). The survival outcomes after HT in children have improved considerably in recent years. However, allograft rejection and cardiac allograft vasculopathy remain the leading cause of death or re-transplantation. The routine surveillance by EMB and coronary angiography are invasive and risky. Newer noninvasive echocardiographic techniques, including tissue Doppler imaging (TDI), 2-D speckle tracking echocardiography, CT coronary angiography (CTCA), cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) and invasive techniques such as intravascular ultrasound (IVUS), functional flow reserve (CFR) of coronary arteries, optical coherence tomography (OCT), have emerged as powerful tools which may help early recognition of sub-clinical rejection, response to treatment, early detection, and progression of CAV. The multimodality imaging approach, including noninvasive and invasive tests, is the future for the transplanted heart to detect dysfunction, rejections, and early CAV. This review illustrates noninvasive and invasive imaging techniques currently used or could be considered for clinical use in detecting heart transplant rejection, dysfunction, and CAV in children.
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4
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Impaired left atrial function in clinically well heart transplant patients. Int J Cardiovasc Imaging 2021; 37:1937-1945. [PMID: 33620609 DOI: 10.1007/s10554-021-02177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
Left atrial (LA) enlargement is present in the majority of adult heart transplant (HT) recipients. We used speckle-tracking echocardiography to investigate whether LA phasic function in HT patients is altered and explored its relationship to HT-related clinical variables. This study evaluated LA function in 112 clinically well HT patients and 40 healthy controls. Clinical data included recipient age at HT, donor age, ischemia time, left ventricular function, and biochemical indicators. Atrial deformation and volume indices were measured with two-dimensional and three-dimensional speckle-tracking echocardiography, respectively. Components of phasic atrial function were calculated and correlations to clinical variables were explored. Compared with controls, HT patients had worse LA reservoir, conduit, and pump function. LA reservoir function of the bicaval group was better than the biatrial group, but differences did not persist after adjustment for potential confounders. Among patients with HT, those with lower LAS-peak had an older recipient age, larger LA volume, as well as worse left ventricular systolic function than those patients with higher LAS-peak. However, E/e', biochemical indicators and donor-related information were similar across the quartiles of LA function. In HT cohort, we observed impairment in all phases of LA function, and LA reservoir function was decreased independent of surgical technique. LAS-peak was associated with worse left ventricular systolic function, which suggested that LA function may play an important role in HT patients.
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Loar RW, George A, Varghese NP, Liu AM, Colquitt JL, Pignatelli RH. Assessing the atria in pediatric sickle cell disease: Beyond the dilation. Echocardiography 2020; 38:189-196. [PMID: 33336441 DOI: 10.1111/echo.14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diastolic dysfunction (DD) and pulmonary hypertension (PH) are common causes of mortality for sickle cell disease (SCD) patients in developed countries. We hypothesized that left and right atrial strain (LAS-Ɛ, RAS-rƐ) are decreased in SCD adolescents, and that worsening values correlate with laboratory markers of disease severity. METHODS Prospective cohort study of patients with HbSS genotype of SCD was compared with healthy controls. LAS and RAS were measured from 4- and 2-chamber views by a blinded reader. Peak strain and strain rate values were obtained for atrial contraction (ac), reservoir (res), and conduit (con) phases. Mitral/tricuspid Doppler velocities, left atrial volume, right atrial area were obtained. Laboratory variables were obtained from the electronic record with the three prior values being averaged. Differences in variables were assessed with Wilcoxon rank sum test, and correlations assessed with Spearman's coefficient. RESULTS There were 33 SCD patients compared to 35 healthy controls of similar age, gender, and size. SCD patients had increased left atrial volume and right atrial area. For LAS, Ɛres was significantly lower in SCD patients. For RAS, RƐcon was significantly lower. Neither measurement correlated with clinical markers. The majority of SCD patients had relatively normal atrial strain values. Those with markedly lower values had similar atrial size. CONCLUSIONS A sub-set of SCD patients have markedly low Ɛres and rƐcon. No correlation with clinical markers was identified. Larger, longitudinal studies may determine utility of atrial strain as a screening tool in this at-risk population.
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Affiliation(s)
- Robert W Loar
- Pediatric Cardiology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Alex George
- Pediatric Hematology/Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nidhy P Varghese
- Pediatric Pulmonology and Pulmonary Hypertension, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Asela M Liu
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - John L Colquitt
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Ricardo H Pignatelli
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
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Li M, Lv Q, Wang S, Zhu S, Li H, Wu C, Dong N, Li Y, Zhang L, Xie M. Assessment of biatrial function in clinically well pediatric bicaval heart transplantation patients by three-dimensional echocardiography. Int J Cardiovasc Imaging 2020; 37:921-929. [PMID: 33048269 DOI: 10.1007/s10554-020-02067-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Atrial size and function are closely correlated with atrial contributions to cardiovascular performance. Therefore, in this study, we aimed to assess atrial size and function in pediatric heart transplantation (HTx) patients using three-dimensional echocardiography (3DE). We enrolled 33 clinically well pediatric HTx patients and 33 healthy controls with a similar distribution of sex and age to the HTx patients. All patients underwent two-dimensional echocardiography (2DE) and 3DE. 2DE- and 3DE-derived biatrial maximal volume (Vmax), minimal volume (Vmin), ejection volume (EV), ejection fraction (EF), volume before atrial contraciton (VpreA), passive EV, passive EF, active EV and active EF were obtained in all patients. The 3D left atrail (LA) Vmax, Vmin and VpreA increased significantly in HTx patients after being indexed by BSA, while 3D LAEV and passive EV decreased significantly (P < 0.05). Moreover, the 3D LAEF, LA passive EF, and LA active EF all decreased significantly in HTx patients (P < 0.05). The 3D right atrial (RA) Vmax, Vmin, and VpreA increased significantly in HTx patients (P < 0.05), while the 3D RAEF and RA passive EF decreased significantly in HTx patients (P < 0.05). 3DE-derived LAVmax, LAVpreA, LA passive EV, LAEF, and LA passive EF were all lower than the corresponding 2D parameters. 3DE-derived RAVpreA, RA passive EV and RAEF were all lower than the corresponding 2D parameters. Atrial sizes and function assessed by 3DE- and 2DE-derived parameters, yield significantly discordant results in pediatric HTx patients. 3DE confirms significantly enlarged atrial sizes and decreased atrial functions in pediatric HTx patients.
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Affiliation(s)
- Meng Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuyuan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - He Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Loar RW, Colquitt JL, Rainusso NC, Gramatges MM, Liu AM, Noel CV, Tunuguntla HP, Lilje C, Pignatelli RH. Assessing the left atrium of childhood cancer survivors. Int J Cardiovasc Imaging 2020; 37:155-162. [PMID: 32803485 DOI: 10.1007/s10554-020-01970-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/08/2020] [Indexed: 12/25/2022]
Abstract
Survivors of childhood cancer are at risk of cancer therapy-related cardiac dysfunction (CTRCD) characterized by systolic impairment, with little known about diastolic function. Left atrial strain (LAS) is a surrogate measure of left ventricular filling. We hypothesized that survivors (1) have lower LAS versus controls, and (2) survivors exposed to higher anthracycline dosage have even lower LAS. Cross-sectional study of 45 survivors exposed to anthracyclines ≥ 1 year after chemotherapy and 45 healthy controls. Echo variables included mitral spectral and tissue Doppler, left ventricular ejection fraction (LV EF), LV dimension, LA volume, LV global longitudinal strain (GLS), and LAS. Peak strain (Ɛ) and strain rate (SR) at three phases were obtained: atrial contraction (ac), reservoir (res), and conduit (con). Two sub-analyses of cancer survivors were performed: (1) those with anthracycline dosage ≥ 250 mg/m2, and (2) those with Ɛres in the lowest quartile. On the whole, survivors had lower Ɛres and Ɛcon values. The majority of survivors had relatively normal LAS, while a subset had very low LAS values and were more likely to be older. Survivors exposed to ≥ 250 mg/m2 anthracycline also had lower Ɛres than those < 250 mg/m2. There were no differences in mitral spectral/tissue Doppler, LV dimension, left atrial volume, or GLS. A subset of childhood cancer survivors have lower LAS than their healthy counterparts, while most are essentially normal. Those exposed to higher anthracycline dosage have even lower Ɛres. Longitudinal study of LAS may prove useful in monitoring for CTRCD.
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Affiliation(s)
- Robert W Loar
- Pediatric Cardiology, Cook Children's Medical Center, Fort Worth, TX, USA.
| | - John L Colquitt
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Nino C Rainusso
- Pediatric Hematology/Oncology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
- Pediatric Cardio-Oncology Program, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - M Monica Gramatges
- Pediatric Hematology/Oncology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
- Pediatric Cardio-Oncology Program, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Asela M Liu
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Cory V Noel
- Pediatric Cardiology, Seattle Children's Hospital, Anchorage, AK, USA
| | - Hari P Tunuguntla
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
- Pediatric Cardio-Oncology Program, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Christian Lilje
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
- Pediatric Cardio-Oncology Program, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Ricardo H Pignatelli
- Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
- Pediatric Cardio-Oncology Program, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
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Parthiban A, Jani V, Zhang J, Li L, Craft M, Barnes A, Ballweg JA, Schuster A, Danford DA, Kutty S. Altered Biatrial Phasic Function after Heart Transplantation in Children. J Am Soc Echocardiogr 2020; 33:1132-1140.e2. [PMID: 32653298 DOI: 10.1016/j.echo.2020.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE We used two-dimensional echocardiographic speckle-tracking to investigate whether left and right atrial (LA and RA) phasic function in pediatric heart transplantation (HT) patients is altered and explored the relationship to HT-related clinical variables. METHODS Eighty-six subjects (36 HT and 50 normal children) were prospectively enrolled in two centers. Clinical data included age at HT, bypass time, ischemia time, donor age, and incidence of rejection. Atrial deformation indices including strain and strain rates (SRs) were measured using two-dimensional echocardiographic speckle-tracking. Components of phasic atrial function-reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) were calculated. Comparisons with controls were made using t test or Kruskal-Wallis test, and correlations to clinical variables were explored. RESULTS The mean age and body surface area of HT subjects were 10.2 ± 6.2 years and 1.2 ± 0.6 m2, respectively. The mean heart rates were higher in HT (96 ± 18 vs 88 ± 21 in controls). There were reductions in RA and LA reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) function in HT compared with controls. There was no relationship of LA and RA deformation indices with mean age at HT, bypass time, or ischemia time. The LA εcd correlated weakly with donor age (r = -0.49, P = .04) and RA SRr, and SRcd showed association with duration of HT (P < .05). Nineteen HT recipients had follow-up studies 0.24 ± 0.18 years after the first examination, and deformational indices were not significantly changed. CONCLUSIONS Atrial strain determination is feasible in pediatric HT recipients and demonstrates disruption of reservoir, conduit, and booster function of both atria in this population; we speculate this may be a consequence of ventricular diastolic dysfunction.
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Affiliation(s)
- Anitha Parthiban
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Vivek Jani
- The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jin Zhang
- The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ling Li
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Mary Craft
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Aleissa Barnes
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Jean A Ballweg
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - David A Danford
- Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Shelby Kutty
- The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Loar RW, Pignatelli RH, Morris SA, Colquitt JL, Feagin DK, Denfield SW, Tunuguntla HP. Left Atrial Strain Correlates with Elevated Filling Pressures in Pediatric Heart Transplantation Recipients. J Am Soc Echocardiogr 2020; 33:504-511.e1. [PMID: 31987750 DOI: 10.1016/j.echo.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Noninvasive assessment of diastolic function in pediatric heart transplantation (PHTx) patients is important for monitoring of rejection, cardiac allograft vasculopathy, and nonspecific graft failure. We hypothesized that left atrial strain (LAS) would correlate with pulmonary capillary wedge pressure (PCWP) and that cutoff values to identify elevated left ventricular (LV) filling pressure could be derived for clinical practice and future testing. METHODS This was a secondary analysis of a prospectively collected cohort of PHTx patients undergoing same-day cardiac catheterization with biopsy and transthoracic echo. There were 70 patients with 85 clinical encounters. Traditional mitral inflow Doppler, LAS, LV diastolic strain and strain rate, and ratios for mitral E to LV diastolic strain and strain rate were assessed. Correlation with PCWP was performed, and receiver operator characteristic curves were generated for an elevated mean PCWP, acute rejection, and cardiac allograft vasculopathy. RESULTS Decreased LAS during the atrial reservoir phase (Ɛres) correlated with higher invasively measured PCWP (r = -0.40, P < .001). An Ɛres cutoff of 14.5% had good discriminatory ability for an elevated PCWP (sensitivity 75%, specificity 82%), and Ɛres > 22.0% had 100% negative predictive value; Ɛres was superior to other measures of diastolic function. Subanalyses for recent acute rejection (n = 9) showed good discriminatory ability for Ɛres of 14.5% (sensitivity 89%, specificity 74%). CONCLUSIONS LAS correlates with invasively measured PCWP and can identify elevated pressures better than traditional and other advanced diastolic function parameters. Use of LAS in PHTx patients may aid in noninvasive monitoring for rejection and nonspecific graft dysfunction.
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Affiliation(s)
- Robert W Loar
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
| | - Ricardo H Pignatelli
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Shaine A Morris
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - John L Colquitt
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Douglas K Feagin
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Susan W Denfield
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Hari P Tunuguntla
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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10
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Telles F, Nanayakkara S, Evans S, Patel HC, Mariani JA, Vizi D, William J, Marwick TH, Kaye DM. Impaired left atrial strain predicts abnormal exercise haemodynamics in heart failure with preserved ejection fraction. Eur J Heart Fail 2019; 21:495-505. [PMID: 30652393 DOI: 10.1002/ejhf.1399] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/15/2018] [Accepted: 11/22/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Elevated left atrial (LA) pressure, particularly during exercise, is associated with symptomatic status and survival in patients with heart failure with preserved ejection fraction (HFpEF). We aimed to characterize the contribution of abnormal LA mechanical properties to exercise haemodynamics in HFpEF. METHODS AND RESULTS Simultaneous echocardiography and right heart catheterization were performed in 71 subjects with left ventricular ejection fraction ≥ 50% referred for assessment of exertional dyspnoea. According to haemodynamic evaluation, 49 patients were diagnosed with HFpEF [pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg at rest and/or ≥ 25 mmHg at maximal exertion] and 22 as non-cardiac dyspnoea. Apical two- and four-chamber views were used for blinded two-dimensional LA speckle tracking analysis. HFpEF was characterized by impaired LA reservoir (24.3 ± 9.6 vs. 36.7 ± 8.4%, P < 0.001) and pump strain (-11.5 ± 3.2 vs. -17.0 ± 3.4%, P < 0.001); and increased stiffness (0.8 ± 0.7 vs. 0.2 ± 0.1 mmHg/%, P < 0.001). Reservoir and pump strain correlated with exercise PCWP (r = -0.64 and r = 0.72, P < 0.001), and remained independent predictors after adjusting for left ventricular mass index, LA volume index, mean E/e' and systolic blood pressure (B = -0.66 and B = 1.41, respectively, P < 0.001). LA stiffness was strongly related to B-type natriuretic peptide levels (r = 0.73, P < 0.001; B = 173.0, P < 0.001). Reservoir strain at cut-off of ≤ 33% predicted invasively verified HFpEF diagnosis with 88% sensitivity and 77% specificity, providing a net reclassification improvement of 12% in comparison to the 2016 European Society of Cardiology criteria for non-invasive diagnosis of HFpEF. CONCLUSIONS Impaired LA reservoir and pump function and increased stiffness are associated with abnormal exercise haemodynamics in HFpEF. These markers provide significant HFpEF diagnostic utility in elderly ambulatory patients with dyspnoea.
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Affiliation(s)
- Fernando Telles
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Shane Nanayakkara
- Baker Heart and Diabetes Institute, Melbourne, Australia.,The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Shona Evans
- The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia
| | - Hitesh C Patel
- The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia.,St George's Hospital, London, UK
| | - Justin A Mariani
- The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia
| | - Donna Vizi
- The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia
| | - Jeremy William
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia.,The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Australia.,The Alfred Hospital, Department of Cardiovascular Medicine, Melbourne, Australia.,Monash University, Melbourne, Australia
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11
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Lu JC, Magdo HS, Yu S, Lowery R, Aiyagari R, Zamberlan M, Gajarski RJ. 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. Am J Cardiol 2016; 117:1533-8. [PMID: 26976792 DOI: 10.1016/j.amjcard.2016.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
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.
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12
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13
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Cameli M, Sparla S, Losito M, Righini FM, Menci D, Lisi M, D'Ascenzi F, Focardi M, Favilli R, Pierli C, Fineschi M, Mondillo S. Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction. Echocardiography 2015; 33:398-405. [DOI: 10.1111/echo.13094] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Stefania Sparla
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Maurizio Losito
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | | | - Daniele Menci
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Matteo Lisi
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Flavio D'Ascenzi
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Marta Focardi
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Roberto Favilli
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Carlo Pierli
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Massimo Fineschi
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases; University of Siena; Siena Italy
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14
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Maeder MT, Karapanagiotidis S, Dewar EM, Kaye DM. Accuracy of Echocardiographic Cardiac Index Assessment in Subjects with Preserved Left Ventricular Ejection Fraction. Echocardiography 2015; 32:1628-38. [PMID: 25728504 DOI: 10.1111/echo.12928] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We aimed to determine the accuracy of the echocardiographic assessment of cardiac index (CI) in subjects with preserved left ventricular ejection fraction (LVEF). METHODS Thirty-three subjects with LVEF >50%, normal sinus rhythm, and a broad spectrum of hemodynamic profiles underwent echocardiography immediately followed by right heart catheterization. As gold standards, CI was assessed using thermodilution [CI (TD)] and the Fick method [CI (F)]. Echocardiographic CI was assessed by four methods: from the left ventricular outflow tract (LVOT) velocity time integral and the LVOT diameter as measured [CI (LVOTm)] as well as estimated from body surface area [CI (LVOTe)], and from stroke volume indices assessed using the biplane [CI (BP)] and monoplane [CI (MP)] methods. RESULTS The mean CI (TD), CI (F), CI (LVOTm), CI (LVOTe), CI (BP), and CI (MP) were 3.0 ± 0.9, 3.1 ± 0.7, 2.8 ± 0.6, 3.3 ± 0.6, 2.0 ± 0.6, and 2.2 ± 0.7 L/min/m(2) . There were modest correlations between CI (TD) and CI (F) and all four noninvasive measures of CI with r(2) values ranging from 0.09 to 0.30. CI (LVOTm) underestimated CI (TD) and CI (F) by 0.3 and 0.3 L/min/m(2) , CI (LVOTe) overestimated CI (TD) and CI (F) by 0.3 and 0.2 L/min/m(2) , and CI (BP) and CI (MP) underestimated CI (TD) and CI (F) by 1.1 and 1.1 L/min/m(2) and 0.9 and 0.9 L/min/m(2) , respectively, with large limits of agreement for all comparisons. CONCLUSIONS In subjects with nondilated left ventricles with preserved LVEF, flow- or volume-based measures of CI by 2D echocardiography may not accurately reflect CI (TD) and CI (F). Further larger studies are required to verify our findings and to evaluate the accuracy of contrast and 3D echocardiography in this setting.
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Affiliation(s)
- Micha T Maeder
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Heart Center, Alfred Hospital, Melbourne, Victoria, Australia.,Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sofie Karapanagiotidis
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Heart Center, Alfred Hospital, Melbourne, Victoria, Australia
| | - Elizabeth M Dewar
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Heart Center, Alfred Hospital, Melbourne, Victoria, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Heart Center, Alfred Hospital, Melbourne, Victoria, Australia
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