Echocardiographic Assessment of Right Ventricular Function in Clinically Well Pediatric Heart Transplantation Patients and Comparison With Normal Control Subjects.

TitleEchocardiographic Assessment of Right Ventricular Function in Clinically Well Pediatric Heart Transplantation Patients and Comparison With Normal Control Subjects.
Publication TypeJournal Article
Year of Publication2019
AuthorsWhite BR, Katcoff H, Faerber JA, Lin KY, Rossano JW, Mercer-Rosa L, O'Connor MJ
JournalJ Am Soc Echocardiogr
Volume32
Issue4
Pagination537-544.e3
Date Published2019 Apr
ISSN1097-6795
Abstract

BACKGROUND: Echocardiographic follow-up after pediatric heart transplantation is important because of the lifelong risk for rejection and resultant ventricular dysfunction. Although adult studies have shown that echocardiographic measures of right ventricular function are changed after transplantation, similar results have not been reported in the pediatric population.

METHODS: A single-center retrospective study of echocardiograms obtained among pediatric heart transplant recipients was conducted. All echocardiograms were selected remote from transplantation, rejection, or graft vasculopathy. These criteria identified 127 patients. Right ventricular systolic function was measured using tricuspid annular plane systolic excursion, fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S'). Results were compared with those in 380 healthy age-matched echocardiographic control subjects.

RESULTS: Tricuspid annular plane systolic excursion values in pediatric heart transplant recipients were significantly lower than in control subjects at all ages (P < .0001), with a mean Z score of -3.38. FAC and S' did not vary by age in control patients >6 months of age. FAC values in transplantation patients were significantly decreased compared with those in control subjects (P < .0001), but 83% of transplantation patients had FAC values within the control-derived normal range. S' values were also significantly lower in transplantation patients than control subjects (P < .0001).

CONCLUSIONS: Heart transplantation patients have significantly decreased quantitative metrics of right ventricular function relative to healthy control subjects; longitudinal shortening (tricuspid annular plane systolic excursion and S') is particularly affected. FAC is relatively preserved and may be a better metric in this population. These results establish nomograms of RV function in pediatric heart transplantation patients and in normal pediatric control subjects, which may allow quantification of changes in this vulnerable population.

DOI10.1016/j.echo.2019.01.015
Alternate JournalJ Am Soc Echocardiogr
PubMed ID30954122
PubMed Central IDPMC6452881
Grant ListK01 HL125521 / HL / NHLBI NIH HHS / United States
T32 HL007915 / HL / NHLBI NIH HHS / United States