Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Abstract

Background-Allograft dysfunction is a common finding early after heart transplant (HT). We sought to assess the recovery of left (LV) and right ventricular (RV) function during the first year after HT in children and young adults using pulsedwave tissue Doppler imaging. Methods and Results-We analyzed serially performed echocardiography in 44 pediatric HT recipients (median age: 7.3 years at HT) who remained rejection-free during the first year post-transplant. Age-based normative values for systolic (S′), early-diastolic (E′), and late-diastolic (A′) velocities obtained using pulsed-wave tissue Doppler imaging in 380 healthy children were used to transform patient data into z scores. Pulsed-wave tissue Doppler imaging studies ≤10 days post-HT demonstrated biventricular systolic and diastolic dysfunction with most prominent impairment in RV systolic function (S′ z score −2.7±0.8), RV early-diastolic filling (E′ z score −2.3±1.1), and LV early-diastolic filling (E′ z score −2.3±1.1). LV systolic function (S′ z score) and late-diastolic filling (A′ z score) improved to normal in 11 to 30 days, LV early-diastolic filling (E′ z score) in 4 to 6 months, and RV early-diastolic filling in 6 to 9 months (P<0.001 for all on longitudinal analysis). However, RV systolic function (RV S′ z score −1.2±1.1) remained impaired 1-year post-transplant. Analysis of serial cardiac catheterization studies showed that RV and LV filling pressures were elevated early post-HT and declined gradually during the first year post-transplant. Conclusions-Pediatric

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“…[14][15][16] Our results are in accordance with those, indicating that the transplanted heart cannot be considered as a healthy heart due to several reasons. There are also wide variations in echocardiographic measurements from patient to patient that complicate the definitions of normal limits in heart transplant recipients.…”

Diffuse Myocardial Fibrosis in Children After Heart Transplantations

“…4 Despite these advances, mortality remains significant, and ventricular dysfunction is not uncommon in children after HTx. 5,6 Diffuse myocardial fibrosis is increasingly identified as an important mechanism of myocardial functional decline in a variety of cardiac conditions. An increased amount of fibrosis has been demonstrated by endomyocardial biopsy (EMBx) in adult HTx patients with cardiac allograft vasculopathy (CAV), irrespective of rejection.…”

Evaluación ecocardiográfica de pacientes pediátricos post-trasplante cardiaco en Chile: Aplicación inicial de un protocolo funcional con Strain longitudinal global

“…In previous studies, the use of tissue Doppler imaging has demonstrated biventricular diastolic dysfunction during the first year after heart transplantation 16 . In addition, longitudinal follow-up of transplanted patients has shown that during episodes of rejection, A' and E' velocity decreases at both the septal and lateral mitral annulus 17 .…”