Serial Changes in Right Ventricular Systolic Function Among Rejection-Free Children and Young Adults After Heart Transplantation

Harrington, Jamie K.; Richmond, Marc E.; Woldu, Kristal L.; Pasumarti, Nikhil; Kobsa, Serge; Freud, Lindsay R.

doi:10.1016/j.echo.2019.04.413

Cited by 13 publications

(21 citation statements)

References 47 publications

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“…has previously shown that longitudinal shortening accounts for almost 80% of overall RV function in the normal RV. Post‐operatively and up to 1‐year post‐pericardiectomy, prior findings have consistently shown that RV function, as assessed by various echocardiographic measures, 7,10,12,15,16 including TAPSE, 13 after HTx is initially reduced, then increases in the first year following HTx. Our depiction of the trajectory of TAPSE over time post‐HTx is in accordance with, but also extends, these prior findings as we did not limit our analyses to 1‐year post‐HTx, but rather included the entire follow‐up period (median 6.7 years).…”

Section: Discussionmentioning

confidence: 89%

“…Additionally, RV functional parameters have been found to be associated with meaningful outcomes including mortality, rejection, CAV, and functional capacity 8,9,11,14,18 . However, only few of these studies 7,8,11,13 specifically investigated TAPSE as a measure of RV function. In contrast to the present study, these prior studies, examining TAPSE as a measure of RV function, were either carried out in the pediatric population, 7 or limited to 1‐year post‐HTx, 7,8,13 and none of the studies examined the relation between TAPSE and mortality 7,8,11,13 .…”

Section: Discussionmentioning

confidence: 99%

“…However, only few of these studies 7,8,11,13 specifically investigated TAPSE as a measure of RV function. In contrast to the present study, these prior studies, examining TAPSE as a measure of RV function, were either carried out in the pediatric population, 7 or limited to 1‐year post‐HTx, 7,8,13 and none of the studies examined the relation between TAPSE and mortality 7,8,11,13 . In the present study, we measured TAPSE in adult HTx recipients at any given time point post‐HTx and found significant associations between reduced TAPSE and mortality and CAV, but not ACR and CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, linear echocardiographic parameters such as Tricuspid Annular Plane Systolic Excursion (TAPSE), have been proposed as a reliable measure to assess RV performance. 6 Many previous studies [7][8][9][10][11][12][13][14][15][16][17][18][19] have, in fact, examined RV function in the post-HTx population using various echocardiographic parameters. However, only few of these studies 7,8,11,13 included TAPSE as a measure of RV function, and none of the studies examined the relation between TAPSE and mortality.…”

mentioning

confidence: 99%

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Impact of serial measurements of tricuspid annular plane systolic excursion on mortality and morbidity after heart transplantation

Vishram-Nielsen

Nelson

Fan

et al. 2022

Clinical Transplantation

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The impact of right ventricular (RV) dysfunction on long‐term post‐HTx outcomes remains uncertain. We assessed the impact of serial measurements of Tricuspid Annular Plane Systolic Excursion (TAPSE) on post‐HTx mortality and morbidity. This two‐center retrospective cohort study included consecutive adult HTx recipients (2000–2017). We used multivariable extended hazard regression models to evaluate the association between TAPSE and left ventricular ejection fraction (LVEF), entered as time‐dependent variables, and all‐cause mortality, cardiac allograft vasculopathy (CAV), acute cellular rejection (ACR), and chronic kidney disease (CKD). TAPSE was modelled using cubic splines. We included 485 HTx recipients (9461 TAPSE measurements), median (25th‐ 75th percentile) 19 (10–27) mm; median age was 52 (41–59) years, and 71.3% were male. During a follow‐up of 6.7 (3.0–10.8) years, 92 patients died, 225 had ACR >2R, 234 CAV, and 91 CKD. By multivariable analysis, for each 1‐mm decrease in patients with a TAPSE value <15mm, mortality increased by 22% (P<.001). For the average HTx recipient with a TAPSE of 15mm, 10mm, and 6mm, 1‐year mortality was 3%, 7%, and 17%, and 5‐year mortality was 8%, 20%, and 43%, respectively. Reduced TAPSE was significantly associated with increased CAV but notACR and CKD. A decrease in TAPSE below 15mm represents clinically significant graft dysfunction, warranting close monitoring.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of serial measurements of tricuspid annular plane systolic excursion on mortality and morbidity after heart transplantation

Vishram-Nielsen

Nelson

Fan

et al. 2022

Clinical Transplantation

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“…Previous studies have correlated RV FAC with magnetic resonance imaging among HT recipients. 4 However, abnormal longitudinal parameters, present up to 1 year post‐HT, 5 do not allow differentiation of HT rejection. Our data support the finding that measures of RV radial function may indeed provide a more sensitive non‐invasive marker of RV function.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic assessment of radial right ventricular function in heart transplant recipients

et al. 2021

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Aims Right ventricular (RV) allograft dysfunction is present in half of all heart transplant (HT) recipients. Non‐invasive assessment of RV function in the setting of rejection is not well described. We outline an echocardiographic technique, short‐axis fractional area change (SAXFAC), to evaluate RV function in the HT population and correlate this with the grade of pathologic rejection. Methods and results We retrospectively reviewed the electronic medical records of 110 people who received a HT between 1 January 2015 and 29 February 2020 and had no evidence of rejection. One hundred eighty‐two transthoracic echocardiograms (TTEs) completed up to 1 year from the date of transplantation were analysed for the target acoustic window, the parasternal mid‐ventricular short‐axis view. Sixty‐one TTEs from 23 healthy transplants were deemed appropriate for SAXFAC determination. Thirty‐three organ recipients with at least grade 1R allograft rejection were also identified, and their TTEs screened for SAXFAC analysis. Two expert readers independently calculated SAXFAC as follows: RV end‐diastolic area minus end‐systolic area divided by end‐diastolic area. Using commercially available software (Epsilon, Ann Arbor, Michigan), we quantified RV radial strain, longitudinal strain, and apical fractional area change (FAC). Twenty‐eight transplant recipients with grade 0R or 1R rejection and nine patients with clinically significant rejection completed the study analysis. SAXFAC demonstrated significant variability in the entire population with an inverse relationship to severity of allograft rejection (P ≤ 0.01). Radial strain and FAC were also associated with clinically significant rejection (P ≤ 0.01). Conclusions Short‐axis fractional area change is a simple two‐dimensional technique to assess RV function in HT recipients and showed no significant inter‐observer variability. In our small, single‐centre, retrospective case series, lower SAXFAC values were associated with clinically significant allograft rejection. The small sample size and infrequent occurrence of rejection make our observations hypothesis‐generating only. We advocate dedicated RV SAXFAC imaging planes be included when assessing allograft function.

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Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair

McMullen,

Harrington,

Blitzer

et al. 2024

Pediatr Cardiol

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Serial Changes in Right Ventricular Systolic Function Among Rejection-Free Children and Young Adults After Heart Transplantation

Cited by 13 publications

References 47 publications

Impact of serial measurements of tricuspid annular plane systolic excursion on mortality and morbidity after heart transplantation

Impact of serial measurements of tricuspid annular plane systolic excursion on mortality and morbidity after heart transplantation

Echocardiographic assessment of radial right ventricular function in heart transplant recipients

Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair

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