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

Abstract

The purpose of the study is to determine the association of Doppler tissue imaging (DTI) and catheter-derived measures with rejection in pediatric heart transplant (PHT) recipients and to determine any correlation between DTI and catheter-derived measurements. Sixty echocardiograms were prospectively performed in 37 PHT recipients at the time of surveillance cardiac biopsy. During right-heart cardiac catheterization, sequential pressures of the right heart and pulmonary capillary wedge pressures (PCWP) were measured. DTI was performed to obtain peak systolic (S'), early (E') and late (A') diastolic velocities (cm/s) at tricuspid annulus, septum and mitral annulus. Septal S' and tricuspid annular A' were associated with rejection, but had low sensitivity and specificity. Elevated lateral mitral E/E' did not predict rejection. The mean pulmonary capillary wedge pressure (PCWP) and cardiac index were similar in those with and without rejection. The lateral mitral and septal E/E' did not correlate with PCWP. Some DTI-derived measures were altered during rejection, but were not clinically useful predictors of rejection. Catheter-derived measures were not significantly altered during rejection and did not correlate with DTI-derived measures. None of these measures can replace the current practice of performing cardiac biopsy for surveillance of rejection.

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

“…Other cross-sectional studies in children who were rejection-free at the time of their PW-TDI imaging but had previous rejection history have also documented abnormal tissue velocities compared with controls. 19,20 Our study expands the current knowledge-base by analyzing a larger cohort of HT recipients in a longitudinal study design, following study subjects for a longer duration, transforming raw TDI velocities into age-adjusted z scores and analyzing serial invasive hemodynamic studies performed along a similar time line. Furthermore, although some of the findings of our analysis could be anticipated from previous reports, our analysis provides a broad and integrated view of longitudinal changes in graft function in the contemporary RV dysfunction is an important determinant of early post-HT outcomes.…”

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

“…87 Echocardiogramderived Doppler tissue imaging as a measure of diastolic function has been reported to be an independent predictor of AMR in pediatric heart transplant recipients, although this was not supported by Sachdeva and colleagues. 88 Although diastolic indices can be abnormal in acute rejection in adult heart transplant recipients, the sensitivity and specificity are low. 88,89 Novel methods such as nuclear perfusion and cardiac magnetic resonance imaging may have an evolving role, especially in detecting myocardial edema and increased LV mass.…”

“…88 Although diastolic indices can be abnormal in acute rejection in adult heart transplant recipients, the sensitivity and specificity are low. 88,89 Novel methods such as nuclear perfusion and cardiac magnetic resonance imaging may have an evolving role, especially in detecting myocardial edema and increased LV mass. [90][91][92][93][94][95][96][97] One of the most promising cardiac magnetic resonance imaging modalities is T2 quantification.…”

Is Doppler echocardiography useful for estimating left ventricular filling pressures in pediatric heart transplant recipients?

“…The relationship of LV E/E′ ratio to LV filling pressure has been investigated in several studies of pediatric heart recipients . None of them have found the association of LV E/E′ ratio with LV filling pressures to be robust whether obtained simultaneously, immediately after, within four hours of heart catheterization procedure or whether assessed as PCWP and/or LV end‐diastolic pressure .…”