Early assessment of right ventricular systolic function after pediatric heart transplant

Abstract

RV systolic function is important early after HT; however, it has not been critically assessed in children using quantitative measures. The aim of this study was to describe the most validated and commonly used quantitative echocardiographic measures of RV systolic function early after pediatric HT and to assess associations with qualitative function evaluation and clinical factors. RV systolic function was quantified on the first post-HT echocardiogram >24 hours after cardiopulmonary bypass using two-dimensional TAPSE, Tricuspid annular S', FAC, and MPI. In 145 patients (median age 7.6 years), quantitative RV systolic function was markedly abnormal: mean TAPSE z-score -8.43 ± 1.89; S' z-score -4.36 ± 1.22; FAC 24.4 ± 8.34%; and MPI 0.86 ± 0.51. Few patients had normal quantitative function: TAPSE (0%), S' (1.2%), FAC (9.4%), and MPI (28.4%). In contrast, 48.3% were observed as normal by qualitative assessment. Most clinical factors, including diagnosis, pulmonary vascular resistance, posttransplant hemodynamics, inotropic support, and rejection, were not associated with RV function. In this large pediatric HT population, TAPSE, S', FAC, and MPI were strikingly abnormal early post-HT despite reassuring qualitative assessment and no significant association with clinical factors. This suggests that the accepted normal values of these quantitative measures may not apply in the early post-HT period to accurately grade RV systolic function, and there may be utility in adapting a concept of normal reference values after pediatric HT.

Echocardiographic assessment of pediatric heart transplantation: A single‐center experience in China

“…14 Previous studies described the evolution of right ventricular systolic function of pediatric HT recipients during the first year after transplant. [15][16][17] The reports on evolution of biventricular function of this population are scarce. The evolution of comprehensive echocardiographic parameters of pediatric HT patients and its relations with clinical outcomes needs further investigation.…”

Tricuspid Annular Plane Systolic Excursion (TAPSE) correlates with mean pulmonary artery pressure especially 10 years after pediatric heart transplantation

“…TAPSE has been correlated with qualitative assessment, it has shown positive correlations with right ventricular ejection fraction and fractional area change and a negative correlation with right ventricular end diastolic volume 8,10–13 . TAPSE has become a major echocardiographic parameter in pediatric pulmonary hypertension and other diseases such as Tetralogy of Fallot 9–11,14,15 .…”

“…In patients after HTx, TAPSE has shown a significant correlation with right ventricular fractional area change, acute cellular rejection burden, cardiac allograft vasculopathy and mortality and is therefore an important prognostic parameter in heart transplant recipients 12,13,18,19 …”

“…[5][6][7] TAPSE has been correlated with qualitative assessment, it has shown positive correlations with right ventricular ejection fraction and fractional area change and a negative correlation with right ventricular end diastolic volume. 8,[10][11][12][13] TAPSE has become a major echocardiographic parameter in pediatric pulmonary hypertension and other diseases such as Tetralogy of Fallot. [9][10][11]14,15 It even showed a strong correlation with right ventricular ejection fraction in children with pulmonary hypertension secondary to congenital heart disease and Tetralogy of Fallot.…”

“…16,17 In patients after HTx, TAPSE has shown a significant correlation with right ventricular fractional area change, acute cellular rejection burden, cardiac allograft vasculopathy and mortality and is therefore an important prognostic parameter in heart transplant recipients. 12,13,18,19 To what extent TAPSE correlates with the pulmonary artery pressure even ≥10 years after pediatric HTx and if TAPSE normalizes over the years after pediatric HTx is yet unknown. Thus, the purpose of this study was (1) to evaluate the potential difference of TAPSE between patients even ≥10 years after pediatric HTx and normal values of healthy children and (2) to analyze the correlation between TAPSE and invasively measured pulmonary artery pressure and right ventricular parameters after pediatric HTx.…”