Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

Abstract

Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E' lateral) parameters, and the Doppler-estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E' lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography.

Predictive value of E/A and E/E′ Doppler indexes for cardiac events in heart transplant recipients

“…They suggested that an elevated E/A ratio in HTR is related to reduced left atrial contractility rather than to LV diastolic dysfunction. In contrast, E/A ratio significantly correlated with catheter pulmonary capillary wedge pressure in two other studies . As we found that E/A>2 was associated with cardiac events, our study also suggests that E/A>2 is probably a sign of myocardial fibrosis and CAV of the aging graft.…”

“…Consistently, among the patients of our study with E/A>2, this abnormality occurred in most cases (74%) during the first year after transplantation. Thus, in previous studies, the ability of this ratio to predict high LV filling pressures was controversial . Pascale et al .…”

“…Third, myocardial velocities should be interpreted with caution, because velocities may be affected by exaggerated translation motion of the transplanted heart . Finally, E/E′ ratio correlation with pulmonary wedge pressure in HTR markedly varies from one study to another and some investigators consider that this ratio is not useful in these patients . In the present study, we test whether these indexes are able to predict cardiac events in HTR.…”

“…Moreover, these indexes predict cardiac events in various populations, including patients with hypertension, heart failure, or coronary artery disease . The reliability of these indexes in heart transplant recipients (HTR) has been questioned . First, high heart rate, frequently present in the denervated heart, may result in the fusion of E and A wave .…”

Assessment of Biventricular Function in Clinically Well Pediatric Heart Transplantation Patients by Three-dimensional Speckle Tracking Echocardiography

“…Though some investigators are actively trying to use parameters assessing diastolic function, but the results are con icted, especially in pediatric patients. [16][17][18][19][20][21][22][23] In this study, we pay more attention to the systolic function.…”