Diastolic performance assessed by tissue Doppler after pediatric heart transplantation

Global left ventricular relaxation: A novel tissue Doppler index of acute rejection in pediatric heart transplantation

“…15 The LVRI was not different between the early-transplant group and those with Grade 1R to 3R EMBs (see Figure 3A). This finding reflects the "physiologic" impairment of diastolic function during the first months postOHTx, as previously described by Asante-Korang et al, 7 who found a progressive increase in the diastolic velocity of the left ventricular posterior wall during the first 90 days post-OHTx. Fyfe 16 and Mahle 17 described a change in the early diastolic velocity of the mitral and tricuspid annuli after OHTx, followed by gradual partial recovery after 180 days.…”

“…15 Several pediatric studies have compared echocardiographic parameters, including TDI-derived velocities, in patients with and without OHTx rejection. [3][4][5][6][7] In light of these findings, some centers reported that TDI has become (A) LVRI distribution among the 4 groups of patients. LVRI Z0.8 differentiated Grade 1R to 3R EMB patients and the early post-transplant group from the Grade 0R EMB and control groups.…”

“…2 Studies in adult and pediatric orthotopic heart transplant (OHTx) recipients have shown that myocardial velocities are altered not only at baseline, but also during acute allograft rejection. [3][4][5][6][7] After OHTx, right ventricular endomyocardial biopsy (EMB) plus histologic evaluation of obtained samples constitutes the standard of reference for detection of acute rejection. 8,9 However, EMB procedures have a risk of complications, particularly in the younger pediatric population, among whom rates of cardiac perforation can be as high as 1% to 3%.…”

B-type Natriuretic Peptide Is a Sensitive Screening Test for Acute Rejection in Pediatric Heart Transplant Patients

“…34 The reason for the initial elevation then decrease in BNP levels is not known, but may be in part related to diastolic dysfunction often seen in the initial post-transplant period. 35 Importantly, patients with AR had significantly higher BNP levels compared to patients without AR. This association of BNP levels and AR was highly significant and independent of age, time from transplant, hemodynamic data from the catheterization laboratory and repeated measurements.…”

Doppler tissue imaging and catheter-derived measures are not independent predictors of rejection in pediatric heart transplant recipients

“…Some studies in adult heart transplant recipients have demonstrated changes in DTI derived indices during rejection [6,12,15]. However, there is limited data in this regard in PHT recipients [1,7,13].…”