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Alfares FA, Nanjegowda C, Swaminathan S, Hunter J, Alkon J, Sandhu S, Rusconi P. Echocardiography to predict left ventricular filling pressure for long-term paediatric heart transplant patients. Cardiol Young 2024:1-6. [PMID: 38706324 DOI: 10.1017/s1047951124000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Left ventricular diastolic dysfunction is a recognised sequela following transplantation in paediatric heart transplant patients. Traditional echocardiographic indices do not correlate well with left ventricular filling pressure immediately after transplantation. This study aimed to assess whether these indices have any long-term correlation after transplantation in paediatric patients. METHODS A retrospective chart review of 41 patients who had a heart transplant before the age of 24 years was performed. The median time since the transplantation was 11 years. Data obtained from surveillance cardiac catheterisation and echocardiographic examination were reviewed. Traditional echocardiographic indices of diastolic function were compared with the pulmonary capillary wedge pressure and left ventricular end-diastolic pressure obtained from cardiac catheterisation. RESULTS The median age at transplant was 12.1 years, and the median time since transplant was 11 years. Eighteen patients (43%) had a history of at least one rejection episode and 12 patients (29%) had a history of cardiac allograft vasculopathy. There was no correlation between mitral inflow E velocity, mitral E/A ratio, tissue Doppler velocities, mitral E/e' (mitral inflow E velocity to mitral annular velocity), and elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. There was no correlation between mitral valve deceleration time or isovolumetric relaxation time with elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. CONCLUSION Our findings suggest that traditional echocardiographic indices of diastolic function do not correlate well with elevated invasive pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure in paediatric heart transplant patients' long-term post-transplantation.
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Affiliation(s)
- Fahad A Alfares
- Pediatric Cardiology Unit, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Chetan Nanjegowda
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Juanita Hunter
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jaime Alkon
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Satinder Sandhu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Paolo Rusconi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
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2
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Sciaccaluga C, Natali BM, Righini FM, Sorini Dini C, Landra F, Mandoli GE, Sisti N, Menci D, D'Errico A, D'Ascenzi F, Focardi M, Bernazzali S, Maccherini M, Valente S, Cameli M. Heart transplantation and anti-HLA antibodY: myocardial dysfunction and prognosis - HeartLAy study. ESC Heart Fail 2023; 10:2853-2864. [PMID: 37415291 PMCID: PMC10567642 DOI: 10.1002/ehf2.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
AIMS The presence of anti-human leucocyte antigen (HLA) antibodies has been implicated in a higher incidence of complications as well as mortality rate in heart transplantation. The aim of the study was to identify through non-invasive parameters early signs of myocardial dysfunction in the presence of anti-HLA antibodies but without evidence of antibody-mediated rejection (AMR) and its possible prognostic impact. METHODS AND RESULTS A total of 113 heart-transplanted patients without acute cellular rejection (ACR) and AMR or cardiac allograft vasculopathy (CAV) were prospectively enrolled and divided into two groups ['HLA+' (50 patients) and 'HLA-' (63 patients)], based on the presence of anti-HLA antibodies. Each patient was followed for 2 years after the enrolment, recording episodes of AMR, ACR, CAV, and mortality. Clinical characteristics were similar between the two groups. Among laboratory data, N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin values were significantly higher in the presence of anti-HLA antibodies (P < 0.001 and P = 0.003, respectively). The echocardiographic parameters that showed a statistically significant difference between the two groups were deceleration time of E wave (DecT E, P < 0.001), left ventricular global longitudinal strain (P < 0.001), tricuspid annular plane systolic excursion (P = 0.011), tricuspid S' wave (P = 0.002), and free wall right ventricular longitudinal strain (fwRVLS, P = 0.027), whereas left atrial strain did not differ significantly (P = 0.408). Univariate analysis showed that anti-HLA antibodies were associated with the development of CAV at both 1 and 2 year follow-up [odds ratio (OR) 11.90, 95% confidence interval (CI) 1.43-90.79, P = 0.022 and OR 3.37, 95% CI 1.78-9.67, P = 0.024, respectively]. Bivariate analysis demonstrated that both fwRVLS and DecT E were predictors of CAV development independently from HLA status. CONCLUSIONS The presence of circulating anti-HLA antibodies is correlated with a mild cardiac dysfunction, even in the absence of AMR, and CAV development. Interestingly, reduced values of DecT E and fwRVLS were predictors of future development of CAV, independently from anti-HLA antibody.
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Affiliation(s)
- Carlotta Sciaccaluga
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Benedetta Maria Natali
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | - Carlotta Sorini Dini
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Federico Landra
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Nicolò Sisti
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Daniele Menci
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Marta Focardi
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | | | - Serafina Valente
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
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3
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Saemann L, Georgevici AI, Hoorn F, Gharpure N, Veres G, Korkmaz-Icöz S, Karck M, Simm A, Wenzel F, Szabó G. Improving Diastolic and Microvascular Function in Heart Transplantation with Donation after Circulatory Death. Int J Mol Sci 2023; 24:11562. [PMID: 37511318 PMCID: PMC10380662 DOI: 10.3390/ijms241411562] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
The impact of the machine perfusion of donation after circulatory death (DCD) hearts with the novel Custodiol-N solution on diastolic and coronary microvascular dysfunction is unknown. Porcine DCD-hearts were maintained four hours by perfusion with normothermic blood (DCD-B), hypothermic Custodiol (DCD-C), or Custodiol-N (DCD-CN), followed by one hour of reperfusion with fresh blood, including microvascular and contractile evaluation. In another group (DCD group), one hour of reperfusion, including microvascular and contractile evaluation, was performed without a previous maintenance period (all groups N = 5). We measured diastolic function with a balloon catheter and microvascular perfusion by Laser-Doppler-Technology, resulting in Laser-Doppler-Perfusion (LDP). We performed immunohistochemical staining and gene expression analysis. The developed pressure was improved in DCD-C and DCD-CN. The diastolic pressure decrement (DCD-C: -1093 ± 97 mmHg/s; DCD-CN: -1703 ± 329 mmHg/s; DCD-B: -690 ± 97 mmHg/s; p < 0.05) and relative LDP (DCD-CN: 1.42 ± 0.12; DCD-C: 1.11 ± 0.13; DCD-B: 1.22 ± 0.27) were improved only in DCD-CN. In DCD-CN, the expression of eNOS increased, and ICAM and VCAM decreased. Only in DCD-B compared to DCD, the pathways involved in complement and coagulation cascades, focal adhesion, fluid shear stress, and the IL-6 and IL-17 pathways were upregulated. In conclusion, machine perfusion with Custodiol-N improves diastolic and microvascular function and preserves the microvascular endothelium of porcine DCD-hearts.
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Affiliation(s)
- Lars Saemann
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Adrian-Iustin Georgevici
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
- Department of Anaesthesiology, St. Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Fabio Hoorn
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Faculty Medical and Life Sciences, Furtwangen University, 78054 Villingen-Schwenningen, Germany
| | - Nitin Gharpure
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
| | - Gábor Veres
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sevil Korkmaz-Icöz
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas Simm
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
| | - Folker Wenzel
- Faculty Medical and Life Sciences, Furtwangen University, 78054 Villingen-Schwenningen, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Das B, Deshpande S, Akam-Venkata J, Shakti D, Moskowitz W, Lipshultz SE. Heart Failure with Preserved Ejection Fraction in Children. Pediatr Cardiol 2023; 44:513-529. [PMID: 35978175 DOI: 10.1007/s00246-022-02960-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
Diastolic dysfunction (DD) refers to abnormalities in the mechanical function of the left ventricle (LV) during diastole. Severe LVDD can cause symptoms and the signs of heart failure (HF) in the setting of normal or near normal LV systolic function and is referred to as diastolic HF or HF with preserved ejection fraction (HFpEF). Pediatric cardiologists have long speculated HFpEF in children with congenital heart disease and cardiomyopathy. However, understanding the risk factors, clinical course, and validated biomarkers predictive of the outcome of HFpEF in children is challenging due to heterogeneous etiologies and overlapping pathophysiological mechanisms. The natural history of HFpEF varies depending upon the patient's age, sex, race, geographic location, nutritional status, biochemical risk factors, underlying heart disease, and genetic-environmental interaction, among other factors. Pediatric onset HFpEF is often not the same disease as in adults. Advances in the noninvasive evaluation of the LV diastolic function by strain, and strain rate analysis with speckle-tracking echocardiography, tissue Doppler imaging, and cardiac magnetic resonance imaging have increased our understanding of the HFpEF in children. This review addresses HFpEF in children and identifies knowledge gaps in the underlying etiologies, pathogenesis, diagnosis, and management, especially compared to adults with HFpEF.
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Affiliation(s)
- Bibhuti Das
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Shriprasad Deshpande
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, DC, USA
| | - Jyothsna Akam-Venkata
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Divya Shakti
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - William Moskowitz
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Steven E Lipshultz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, 14203, USA
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5
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Sciaccaluga C, Fusi C, Landra F, Barilli M, Lisi M, Mandoli GE, D’Ascenzi F, Focardi M, Valente S, Cameli M. Diastolic function in heart transplant: From physiology to echocardiographic assessment and prognosis. Front Cardiovasc Med 2022; 9:969270. [DOI: 10.3389/fcvm.2022.969270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Heart transplant (HTx) still represents the most effective therapy for end-stage heart failure, with a median survival time of 10 years. The transplanted heart shows peculiar physiology due to the profound alterations induced by the operation, which inevitably influences several echocardiographic parameters assessed during these patients’ follow-ups. With these premises, the diastolic function is one of the main aspects to take into consideration. The left atrium (LA) plays a key role in this matter, and that same chamber is significantly impaired with the transplant, with different degrees of altered function based on the surgical technique. Therefore, the traditional echocardiographic evaluation of diastolic function applied to the general population might not properly reflect the physiology of the graft. This review attempts to provide current evidence on diastolic function in HTx starting from defining its different physiology and how the standard echocardiographic parameters might be affected to its prognostic role. Furthermore, based on the experience of our center and the available evidence, we proposed an algorithm that might help clinicians distinguish from actual diastolic dysfunction from a normal diastolic pattern in HTx population.
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6
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Das BB. Therapeutic Approaches in Heart Failure with Preserved Ejection Fraction (HFpEF) in Children: Present and Future. Paediatr Drugs 2022; 24:235-246. [PMID: 35501560 DOI: 10.1007/s40272-022-00508-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/29/2022]
Abstract
For a long time, pediatric heart failure (HF) with preserved systolic function (HFpEF) has been noted in patients with cardiomyopathies and congenital heart disease. HFpEF is infrequently reported in children and instead of using the HFpEF terminology the HF symptoms are attributed to diastolic dysfunction. Identifying HFpEF in children is challenging because of heterogeneous etiologies and unknown pathophysiological mechanisms. Advances in echocardiography and cardiac magnetic resonance imaging techniques have further increased our understanding of HFpEF in children. However, the literature does not describe the incidence, etiology, clinical features, and treatment of HFpEF in children. At present, treatment of HFpEF in children is extrapolated from clinical trials in adults. There are significant differences between pediatric and adult HF with reduced ejection fraction, supported by a lack of adequate response to adult HF therapies. Evidence-based clinical trials in children are still not available because of the difficulty of conducting trials with a limited number of pediatric patients with HF. The treatment of HFpEF in children is based upon the clinician's experience, and the majority of children receive off-level medications. There are significant differences between pediatric and adult HFpEF pharmacotherapies in many areas, including side-effect profiles, underlying pathophysiologies, the β-receptor physiology, and pharmacokinetics and pharmacodynamics. This review describes the present and future treatments for children with HFpEF compared with adults. This review also highlights the need to urgently test new therapies in children with HFpEF to demonstrate the safety and efficacy of drugs and devices with proven benefits in adults.
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Affiliation(s)
- Bibhuti B Das
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, 2500 N State St., Jackson, MS, 39216, USA.
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7
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Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type natriuretic peptide. Cardiol Young 2022; 32:531-538. [PMID: 34167609 DOI: 10.1017/s104795112100247x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters. METHODS A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data. RESULTS Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e', and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e' were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index. CONCLUSIONS B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.
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8
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Masarone D, Kittleson M, Gravino R, Valente F, Petraio A, Pacileo G. The Role of Echocardiography in the Management of Heart Transplant Recipients. Diagnostics (Basel) 2021; 11:diagnostics11122338. [PMID: 34943575 PMCID: PMC8699946 DOI: 10.3390/diagnostics11122338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 01/30/2023] Open
Abstract
Transthoracic echocardiography is the primary non-invasive modality for the investigation of heart transplant recipients. It is a versatile tool that provides comprehensive information on cardiac structure and function. Echocardiography is also helpful in diagnosing primary graft dysfunction and evaluating the effectiveness of therapeutic approaches for this condition. In acute rejection, echocardiography is useful with suspected cellular or antibody-mediated rejection, with findings confirmed and quantified by endomyocardial biopsy. For identifying chronic rejection, ultrasound has a more significant role and, in some specific patients (e.g., patients with renal failure), it may offer a role comparable to coronary angiography to identify cardiac allograft vasculopathy. This review highlights the usefulness of echocardiography in evaluating normal graft function and its role in the management of heart transplant recipients.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
- Correspondence:
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA;
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplantology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy;
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
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9
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Lim HS, Ranasinghe A, Quinn D, Chue CD, Mascaro J. Pathophysiology of severe primary graft dysfunction in orthotopic heart transplantation. Clin Transplant 2021; 35:e14398. [PMID: 34176143 DOI: 10.1111/ctr.14398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A series of insults on the donor heart result in pathophysiological changes that manifest as primary graft dysfunction (PGD) post-orthotopic heart transplantation. The objectives of this study were: (i) describe the pathophysiology of severe PGD using an established cardiovascular model; and (ii) the evolution of the pathophysiology during recovery from severe PGD. METHODS Hemodynamic data from 20 consecutive patients with severe PGD (need for mechanical circulatory support, MCS) at baseline (T0), 6 h (T6) and "recovery" (explant of support), and 20 consecutive patients without severe PGD were used to model the pathophysiology using the cardiovascular model described by Burkhoff and Dickstein. RESULTS There was a progressive (from T0 to T6) up- and leftward shift in the diastolic pressure-volume relationship, especially of the right ventricle (RV), resulting in reduced capacitance. RV end-systolic elastance (Ees) was significantly elevated in severe PGD but preload-recruitable stroke work (PRSW) was significantly lower compared to patients without severe PGD. "Recovery" (after liberation from MCS) was associated with improvement in RV Ees, chamber capacitance and PRSW, although they remained significantly lower than patients without severe PGD. CONCLUSION Severe PGD of the dominant right heart failure phenotype is characterized by reduced chamber capacitance, increased "stiffness" and impaired contractility. Complete normalization was not required for successful weaning of MCS.
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Affiliation(s)
- Hoong Sern Lim
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aaron Ranasinghe
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Quinn
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Colin D Chue
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jorge Mascaro
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Alnsasra H, Asleh R, Oh JK, Maleszewski JJ, Lerman A, Toya T, Chandrasekaran K, Bois MC, Kushwaha SS. Impact of Sirolimus as a Primary Immunosuppressant on Myocardial Fibrosis and Diastolic Function Following Heart Transplantation. J Am Heart Assoc 2020; 10:e018186. [PMID: 33325244 PMCID: PMC7955460 DOI: 10.1161/jaha.120.018186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial fibrosis is an important contributor for development of diastolic dysfunction. We investigated the impact of sirolimus as primary immunosuppression on diastolic dysfunction and fibrosis progression among heart transplantation recipients. Methods and Results In 100 heart transplantation recipients who were either treated with a calcineurin inhibitor (CNI) (n=51) or converted from CNI to sirolimus (n=49), diastolic function parameters were assessed using serial echocardiograms and right heart catheterizations. Myocardial fibrosis was quantified on serial myocardial biopsies. After 3 years, lateral e′ increased within the sirolimus group but decreased in the CNI group (0.02±0.04 versus −0.02±0.04 m/s delta change; P=0.003, respectively). Both pulmonary capillary wedge pressure and diastolic pulmonary artery pressure significantly decreased in the sirolimus group but remained unchanged in the CNI group (−1.50±2.59 versus 0.20±2.20 mm Hg/year; P=0.02; and −1.72±3.39 versus 0.82±2.59 mm Hg/year; P=0.005, respectively). A trend for increased percentage of fibrosis was seen in the sirolimus group (8.48±3.17 to 10.10±3.0%; P=0.07) as compared with marginally significant progression in the CNI group (8.76±3.87 to 10.56±4.34%; P=0.04). The percent change in fibrosis did not differ significantly between the groups (1.62±4.67 versus 1.80±5.31%, respectively; P=0.88). Conclusions Early conversion to sirolimus is associated with improvement in diastolic dysfunction and filling pressures as compared with CNI therapy. Whether this could be attributed to attenuation of myocardial fibrosis progression with sirolimus treatment warrants further investigation.
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Affiliation(s)
- Hilmi Alnsasra
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Rabea Asleh
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN.,Department of Cardiology Hadassah University Medical Center Jerusalem Israel
| | - Jae K Oh
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Amir Lerman
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Takumi Toya
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Melanie C Bois
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN
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11
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Schmidt T, Bjarnason-Wehrens B, Predel HG, Reiss N. Exercise after Heart Transplantation: Typical Alterations,
Diagnostics and Interventions. Int J Sports Med 2020; 42:103-111. [DOI: 10.1055/a-1194-4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractFor the treatment of terminal heart failure, heart transplantation is considered
to be the gold standard, leading to significantly improved quality of life and
long-time survival. For heart transplant recipients, the development and
maintenance of good functional performance and adequate exercise capacity is
crucial for renewed participation and integration in self-determined live. In
this respect, typical transplant-related alterations must be noted that play a
significant role, leading to restrictions both centrally and peripherally.
Before patients begin intensive and structured exercise training, a
comprehensive diagnosis of their exercise capacity should take place in order to
stratify the risks involved and to plan the training units accordingly.
Particularly endurance sports and resistance exercises are recommended to
counter the effects of the underlying disease and the immunosuppressive
medication. The performance level achieved can vary considerably depending on
their individual condition, from gentle activity through a non-competitive-level
to intensive competitive sports. This paper includes an overview of the current
literature on heart transplant recipients, their specific characteristics, as
well as typical cardiovascular and musculoskeletal alterations. It also
discusses suitable tools for measuring exercise capacity, recommendations for
exercise training, required precautions and the performance level usually
achieved.
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Affiliation(s)
- Thomas Schmidt
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad
Rothenfelde, Bad Rothenfelde, Germany
- Department of Preventive and Rehabilitative Sport and Exercise
Medicine, Institute for Cardiology and Sports Medicine, Cologne, German Sport
University Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise
Medicine, Institute for Cardiology and Sports Medicine, Cologne, German Sport
University Cologne, Germany
| | - Hans-Georg Predel
- Department of Preventive and Rehabilitative Sport and Exercise
Medicine, Institute for Cardiology and Sports Medicine, Cologne, German Sport
University Cologne, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad
Rothenfelde, Bad Rothenfelde, Germany
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12
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Oreschak K, Wolfel EE, Saba LM, Ambardekar AV, Lindenfeld J, Aquilante CL. Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients. Clin Transplant 2020; 34:e13842. [PMID: 32090364 DOI: 10.1111/ctr.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients. METHODS This retrospective, cross-sectional study included adult heart transplant recipients at least 6 months post-transplant. Ambulatory BP measurements were recorded over 24 hours. Nondippers were defined as a decline in average nighttime BP ≤ 10% compared with daytime. Primary outcomes were the presence of end organ damage, that is, microalbuminuria, chronic kidney disease, and/or left ventricular hypertrophy. Secondary outcomes were measures of diastolic dysfunction (ie, mitral valve deceleration time, e/e', E/A, and isovolumetric relaxation time), microalbumin/creatinine ratio, eGFR, interventricular septal thickness, and left ventricular posterior wall thickness. RESULTS Of 30 patients, 53.3% (n = 16) were systolic nondippers and 40% (n = 12) were diastolic nondippers. Diastolic nondippers had three times higher urine microalbumin/creatinine ratios than diastolic dippers (P = .03). Systolic nondippers had 16.3% lower mitral valve deceleration time (P = .05) than systolic dippers, while diastolic nondippers had 20.4% higher e/e' (P = .05) than diastolic dippers. There were no significant relationships between BP dipping status and any of the primary outcomes. CONCLUSIONS These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients.
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Affiliation(s)
- Kris Oreschak
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Eugene E Wolfel
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura M Saba
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Amrut V Ambardekar
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - JoAnn Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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13
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Cruz Rodriguez JB, Stewart GC, Pamboukian SV, Tallaj JA, Rajapreyar I, Kirklin JK, Holman WL, Hoopes CW, Mukherjee D, Mallawaarachchi I, Dwivedi A, Acharya D. Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation. Artif Organs 2020; 44:E382-E393. [PMID: 32242954 DOI: 10.1111/aor.13692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 01/14/2023]
Abstract
Limited data exist regarding patients with continuous-flow left ventricular assist device (LVAD) support who require long-term inotropes. Our primary objective was to evaluate the clinical characteristics and all-cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re-initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias. Retrospective cohort study was conducted on adult patients with primary continuous-flow LVADs implanted from January 2008 to February 2017 and the patients were followed up through February 2018. We defined PIU as ≥14 days of inotrope support. Kaplan-Meier method, competing risk models and Cox proportional hazard models were used. Final analytic sample was 203 patients, 58% required PIU, and 10% were discharged on inotropes. There was no difference in preimplant characteristics. One-year survival rate was 87% if no PIU required, 74% if PIU required, and 72% if discharged on inotropes. PIU was associated with longer length of stay and higher incidence of GIB. We found no association between PIU and late re-initiation of inotropes, infection or arrhythmias. Adjusted hazard risk of death was increased in patients with PIU (HR = 1.66, P = .046), older age (HR = 1.28, P = .031), and higher creatinine levels (HR = 1.60, P = .007). Prolonged inotrope use is frequently encountered following LVAD implantation and is associated with adverse prognosis but remains a therapeutic option. Inability to wean inotropes prior to hospital discharge is a marker of patients at particularly higher risk of mortality following LVAD implantation.
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Affiliation(s)
- Jose B Cruz Rodriguez
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Cardiovascular Diseases, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose A Tallaj
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Indranee Rajapreyar
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William L Holman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles W Hoopes
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Debabrata Mukherjee
- Division of Cardiovascular Diseases, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
| | - Indika Mallawaarachchi
- Department of Epidemiology, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
| | - Alok Dwivedi
- Department of Epidemiology, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
| | - Deepak Acharya
- Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, USA
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14
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A Predictive Model for Intracardiac Pressures in Patients Free From Rejection or Allograft Vasculopathy After Pediatric Heart Transplantation. Transplantation 2020; 104:e174-e181. [PMID: 32044891 DOI: 10.1097/tp.0000000000003166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the routine use of hemodynamic assessment in pediatric heart transplant (HT) patients, expected intracardiac pressure measurements in patients free of significant complications are incompletely described. A better understanding of the range of intracardiac pressures in these HT patients is important for the clinical interpretation of these indices and consequent management of patients. METHODS We conducted a retrospective chart review of pediatric HT recipients who had undergone HT between January 2010 and December 2015 at Lucile Packard Children's Hospital. We analyzed intracardiac pressures measured in the first 12 mo after HT. We excluded those with rejection, graft coronary artery disease, mechanical support, or hemodialysis. We used a longitudinal general additive model with bootstrapping technique to generate age and donor-recipient size-specific curves to characterize filling pressures through 1-y post-HT. RESULTS Pressure measurements from the right atrium, pulmonary artery, and pulmonary capillary wedge pressure were obtained in 85 patients during a total of 829 catheterizations. All pressure measurements were elevated in the immediate post-HT period and decreased to a stable level by post-HT day 90. Pressure measurements were not affected by age group, donor-recipient size differences, or ischemic time. CONCLUSIONS Intracardiac pressures are elevated in the early post-HT period and decrease to levels typical of the native heart by 90 d. Age, donor-to-recipient size differences, and ischemic time do not contribute to differences in expected intracardiac pressures in the first year post-HT.
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15
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Loar RW, Pignatelli RH, Morris SA, Colquitt JL, Feagin DK, Denfield SW, Tunuguntla HP. Left Atrial Strain Correlates with Elevated Filling Pressures in Pediatric Heart Transplantation Recipients. J Am Soc Echocardiogr 2020; 33:504-511.e1. [PMID: 31987750 DOI: 10.1016/j.echo.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Noninvasive assessment of diastolic function in pediatric heart transplantation (PHTx) patients is important for monitoring of rejection, cardiac allograft vasculopathy, and nonspecific graft failure. We hypothesized that left atrial strain (LAS) would correlate with pulmonary capillary wedge pressure (PCWP) and that cutoff values to identify elevated left ventricular (LV) filling pressure could be derived for clinical practice and future testing. METHODS This was a secondary analysis of a prospectively collected cohort of PHTx patients undergoing same-day cardiac catheterization with biopsy and transthoracic echo. There were 70 patients with 85 clinical encounters. Traditional mitral inflow Doppler, LAS, LV diastolic strain and strain rate, and ratios for mitral E to LV diastolic strain and strain rate were assessed. Correlation with PCWP was performed, and receiver operator characteristic curves were generated for an elevated mean PCWP, acute rejection, and cardiac allograft vasculopathy. RESULTS Decreased LAS during the atrial reservoir phase (Ɛres) correlated with higher invasively measured PCWP (r = -0.40, P < .001). An Ɛres cutoff of 14.5% had good discriminatory ability for an elevated PCWP (sensitivity 75%, specificity 82%), and Ɛres > 22.0% had 100% negative predictive value; Ɛres was superior to other measures of diastolic function. Subanalyses for recent acute rejection (n = 9) showed good discriminatory ability for Ɛres of 14.5% (sensitivity 89%, specificity 74%). CONCLUSIONS LAS correlates with invasively measured PCWP and can identify elevated pressures better than traditional and other advanced diastolic function parameters. Use of LAS in PHTx patients may aid in noninvasive monitoring for rejection and nonspecific graft dysfunction.
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Affiliation(s)
- Robert W Loar
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
| | - Ricardo H Pignatelli
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Shaine A Morris
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - John L Colquitt
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Douglas K Feagin
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Susan W Denfield
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Hari P Tunuguntla
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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16
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Dolan RS, Rahsepar AA, Blaisdell J, Sarnari R, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Yancy CW, Anderson AS, Carr JC, Markl M. Donor and Recipient Characteristics in Heart Transplantation Are Associated with Altered Myocardial Tissue Structure and Cardiac Function. Radiol Cardiothorac Imaging 2019; 1:e190009. [PMID: 32076670 PMCID: PMC6939741 DOI: 10.1148/ryct.2019190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To use structure-function cardiac MRI in the evaluation of relationships between donor and heart transplantation (HTx) recipient characteristics and changes in cardiac tissue structure and function. HTx candidates and donor hearts are evaluated for donor-recipient matches to improve survival, but the impact of donor and recipient characteristics on changes in myocardial tissue and function in the transplanted heart is not fully understood. MATERIALS AND METHODS Cardiac MRI at 1.5 T was performed from August 2014 to June 2017 in 58 HTx recipients (mean age, 51.1 years ± 12.6 [standard deviation], 26 female patients) and included T2 mapping (to evaluate edematous and/or inflammatory changes), precontrast and postcontrast T1 mapping (allowing the calculation of extracellular volume fraction [ECV] to estimate interstitial expansion), and tissue phase mapping (allowing the calculation of myocardial velocities and twist). Donor and recipient demographics (age, sex, height, weight, and body mass index [BMI]) and comorbidities (hypertension, diabetes, and smoking history) were evaluated for relationships with cardiac MRI measures. RESULTS Sex-influenced cardiac MRI measures of myocardial tissue and function are as follows: Female HTx recipients demonstrated increased precontrast T1 (P = .002) and reduced systolic peak long-axis velocities (P = .015). Increased age of the donor heart was associated with elevated T2 (r = 0.32; P < .05) and ECV (r = 0.47; P < .01), indicating increased edema and interstitial expansion, as well as impaired diastolic peak long-axis velocities (r = 0.41; P < .01). Recipient-donor differences in age, weight, and BMI were significantly associated with elevated ECV (r = 0.36-0.48; P < .05). Hypertension in donors resulted in increased ECV (31.0% ± 4.2 vs 26.0% ± 3.3; P = .001). CONCLUSION Donor and HTx recipient characteristics were significantly associated with cardiac MRI-derived measures of myocardial tissue structure and function.© RSNA, 2019.
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Affiliation(s)
- Ryan S. Dolan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Amir A. Rahsepar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Julie Blaisdell
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Roberto Sarnari
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Kambiz Ghafourian
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jane E. Wilcox
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Sadiya S. Khan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Esther E. Vorovich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jonathan D. Rich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Clyde W. Yancy
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Allen S. Anderson
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - James C. Carr
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Michael Markl
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
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17
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Gellner B, Xin L, Pinto Ribeiro RV, Bissoondath V, Adamson MB, Yu F, Lu P, Paradiso E, Mbadjeu Hondjeu AR, Simmons CA, Badiwala MV. The implementation of physiological afterload during ex situ heart perfusion augments prediction of posttransplant function. Am J Physiol Heart Circ Physiol 2019; 318:H25-H33. [PMID: 31774696 DOI: 10.1152/ajpheart.00427.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ex situ heart perfusion (ex situ heart perfusion) is an emerging technique that aims to increase the number of organs available for transplantation by augmenting both donor heart preservation and evaluation. Traditionally, ex situ heart perfusion has been performed in an unloaded Langendorff mode, though more recently groups have begun to use pump-supported working mode (PSWM) and passive afterload working mode (PAWM) to enable contractile evaluation during ex situ heart perfusion. To this point, however, neither the predictive effectiveness of the two working modes nor the predictive power of individual contractile parameters has been analyzed. In this article, we use our previously described system to analyze the predictive relevance of a multitude of contractile parameters measured in each working mode. Ten porcine hearts were excised and perfused ex situ in Langendorff mode for 4 h, evaluated using pressure-volume catheterization in both PSWM and PAWM, and transplanted into size-matched recipient pigs. After 3 h, hearts were weaned from cardiopulmonary bypass and evaluated. When correlating posttransplant measurements to their ex situ counterparts, we report that parameters measured in both modes show sufficient power (Spearman rank coefficient > 0.7) in predicting global posttransplant function, characterized by cardiac index and preload recruitable stroke work. For the prediction of specific posttransplant systolic and diastolic function, however, a large discrepancy between the two working modes was observed. With 9 of 10 measured posttransplant parameters showing stronger correlation with counterparts measured in PAWM, it is concluded that PAWM allows for a more detailed and nuanced prediction of posttransplant function than can be made in PSWM.NEW & NOTEWORTHY Ex situ heart perfusion has been proposed as a means to augment the organ donor pool by improving organ preservation and evaluation between donation and transplantation. Using our multimodal perfusion system, we analyzed the impact of using a "passive afterload working mode" for functional evaluation as compared with the more traditional "pump-supported working mode." Our data suggests that passive afterload working mode allows for a more nuanced prediction of posttransplant function in porcine hearts.
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Affiliation(s)
- Bryan Gellner
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.,Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Liming Xin
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Roberto Vanin Pinto Ribeiro
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ved Bissoondath
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mitchell B Adamson
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Frank Yu
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Pengzhou Lu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Emanuela Paradiso
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Arnaud Romeo Mbadjeu Hondjeu
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Craig A Simmons
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.,Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mitesh V Badiwala
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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18
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Commentary: How long until a new heart is a "normal" heart in transplanted single-ventricle patients? J Thorac Cardiovasc Surg 2019; 159:1997-1998. [PMID: 31711623 DOI: 10.1016/j.jtcvs.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022]
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19
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Lunze FI, Narciso R, Gauvreau K, Blume ED, Colan SD, Singh TP. Is Doppler echocardiography useful for estimating left ventricular filling pressures in pediatric heart transplant recipients? Pediatr Transplant 2019; 23:e13543. [PMID: 31313435 DOI: 10.1111/petr.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022]
Abstract
LV E/E' ratio obtained using Doppler echocardiography is considered a surrogate for LV filling pressure in adults but has performed poorly in children. We hypothesized that LV E/E' ratio Z-score, adjusted for age, will relate more strongly to LV filling pressures than LV E/E' ratio in pediatric HT recipients. We analyzed 751 echocardiograms performed within 24 hours of a heart catheterization in 122 pediatric HT recipients (median age at HT 13 years, median 6 studies per patient). The primary end-point was PCWP, assessed both as a continuous and a binary variable. Associations with LV E/E' ratios and z-scores were assessed using generalized estimating equations models. PCWP, LV E/E' ratios (using E' from LV free wall, septum, and their average), and LV E/E' ratio Z-scores, all declined over time after HT. LV E/E' ratios and their Z-scores were significantly associated with PCWP assessed as a continuous variable (P < 0.001 for all); however, the relationship was weak (R2 range, 0.083 to 0.121). LV E/E' ratios and their Z-scores were also significantly associated with PCWP as a binary variable (P < 0.001 for all) but with only modest ability to discriminate PCWP ≥15 mm Hg (c-statistic range, 0.660 to 0.695). The association between LV E/E' ratio and PCWP in pediatric HT recipients is modest. Using a LV E/E' ratio Z-score did not result in significantly improved association with PCWP. Current Doppler echocardiographic methods are unreliable for estimating LV filling pressures in pediatric HT recipients.
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Affiliation(s)
- Fatima I Lunze
- Department of Congenital Heart Disease, Pediatric Cardiology, German Heart Institute, Berlin, Germany.,Departments of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ryan Narciso
- Departments of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Kimberlee Gauvreau
- Departments of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elizabeth D Blume
- Departments of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Steven D Colan
- Departments of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Tajinder P Singh
- Departments of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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20
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The Effect of Obstructive Sleep Apnea on 3-Year Outcomes in Patients Who Underwent Orthotopic Heart Transplantation. Am J Cardiol 2019; 124:51-54. [PMID: 31029415 DOI: 10.1016/j.amjcard.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
Despite the well-known association between obstructive sleep apnea (OSA) and cardiovascular disease, there is a paucity of data regarding OSA in orthotopic heart transplant (OHT) recipients and its effect on clinical outcomes. Hence, we sought to determine the association between OSA, as detected by polysomnography, and late graft dysfunction (LGD) after OHT. In this retrospective review of consecutive OHT recipients from 2012 to 2014 at our center, we examined LGD, i.e., graft failure >1 year after OHT, through competing risks analysis. Due to small sample size and event counts, as well as preliminary testing which revealed statistically similar demographics and outcomes, we pooled patients who had treated OSA with those who had no OSA. Of 146 patients, 29 (20%) had untreated OSA, i.e., OSA without use of continuous positive airway pressure therapy, at the time of transplantation. Patients with untreated OSA were significantly older, heavier, and more likely to have baseline hypertension than those with treated/no OSA. Although there were no differences between groups in regard to short-term complications of acute kidney injury, cardiac allograft vasculopathy, or primary graft dysfunction, there were significant differences in the occurrence of LGD. Those with untreated OSA were at 3 times the risk of developing LGD than those with treated/no OSA (hazard ratio 3.2; 95% confidence interval 1.3 to 7.9; p = 0.01). Because OSA is a common co-morbidity of OHT patients and because patients with untreated OSA have an elevated risk of LGD, screening for and treating OSA should occur during the OHT selection period.
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Schroeder LW, Chowdhury SM, Burnette AL, Kavarana MN, Baker GH, Savage AJ, Atz AM, Butts RJ. Longer Ischemic Time is Associated with Increased Ventricular Stiffness as Measured by Pressure-Volume Loop Analysis in Pediatric Heart Transplant Recipients. Pediatr Cardiol 2018; 39:324-328. [PMID: 29090350 PMCID: PMC5799027 DOI: 10.1007/s00246-017-1758-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/24/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the associations between clinical factors and cardiac function as measured by pressure-volume loops (PVLs) in a pediatric heart transplant cohort. METHODS Patients (age < 20 years) who underwent heart transplantation presenting for a clinically indicated catheterization were enrolled. PVLs were recorded using microconductance catheters (CD Leycom®, Zoetermeer, Netherlands). Demographic data, serum B-type natriuretic peptide (BNP), time from transplant, ischemic time, presence of transplant coronary artery disease, donor-specific antibodies, and history of rejection were recorded at the time of catheterization. PVL data included contractility indices: end-systolic elastance and preload recruitable stroke work; ventricular-arterial coupling index; ventricular stiffness constant, Beta; and isovolumic relaxation time constant, tau. Associations between PVL measures and clinical data were investigated using non-parametric statistical tests. RESULTS A total of 18 patients were enrolled. Median age was 8.7 years (IQR 5-14 years). There were ten males and eight females. Six patients had a history of rejection and ten had positive donor-specific antibodies. There was no transplant coronary artery disease. Median BNP was 100 pg/mL (IQR 46-140). Time from transplant to PVL obtained during catheterization procedure was 4.1 years (IQR 1.7-7.8 year). No single clinical characteristic was statistically significant when correlated with PVL data. However, longer ischemic time was associated with worse Beta (r = 0.49, p = 0.05). CONCLUSIONS Our study found that longer ischemic times are associated with increased left ventricular stiffness. No other single clinical variable is associated with cardiac dysfunction as determined by PVL analysis.
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Affiliation(s)
- Luke W. Schroeder
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC 29425, USA
| | - Shahryar M. Chowdhury
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC 29425, USA
| | - Ali L. Burnette
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC 29425, USA
| | - Minoo N. Kavarana
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - G. Hamilton Baker
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC 29425, USA
| | - Andrew J. Savage
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC 29425, USA
| | - Andrew M. Atz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC 29425, USA
| | - Ryan J. Butts
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
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Chowdhury SM, Butts RJ, Hlavacek AM, Taylor CL, Chessa KS, Bandisode VM, Shirali GS, Nutting A, Baker GH. Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study. J Am Soc Echocardiogr 2017; 31:342-348.e1. [PMID: 29246510 DOI: 10.1016/j.echo.2017.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric heart transplant recipients are at risk for increased left ventricular (LV) diastolic stiffness. However, the noninvasive evaluation of LV stiffness has remained elusive in this population. The objective of this study was to compare novel echocardiographic measures of LV diastolic stiffness versus gold-standard measures derived from pressure-volume loop (PVL) analysis in pediatric heart transplant recipients. METHODS Patients undergoing left heart catheterization were prospectively enrolled. PVLs were obtained via conductance. The end-diastolic pressure-volume relationship was obtained via balloon occlusion. The stiffness constant, β, was calculated. Echocardiographic measures of diastolic function were derived from spectral and tissue Doppler and two-dimensional speckle-tracking. Ventricular volumes were measured using three-dimensional echocardiography. The novel echocardiographic estimates of ventricular stiffness included E:e'/end-diastolic volume (EDV) and E:early diastolic strain rate/EDV. RESULTS Of 24 children, 18 were heart transplant recipients. Six control patients had hemodynamically insignificant patent ductus arteriosus or coronary fistula. The mean age was 9.1 ± 5.6 years. Median end-diastolic pressure was 9 mm Hg (interquartile range, 8-13 mm Hg). Lateral E:e'/EDV (r = 0.59, P < .01), septal E:e'/EDV (r = 0.57, P < .01), and (E:circumferential early diastolic strain rate)/EDV (r = 0.54, P < .01) correlated with β. Lateral E:e'/EDV displayed a C statistic of 0.93 in detecting patients with abnormal LV stiffness (β > 0.015 mL-1). A lateral E:e'/EDV of >0.15 mL-1 had 89% sensitivity and 93% specificity in detecting an abnormal β. CONCLUSIONS Echocardiographic estimates of ventricular stiffness may be accurate compared with the gold standard in pediatric heart transplant recipients. The clinical usefulness of these noninvasive measures in assessing LV stiffness merits further study in children.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Anthony M Hlavacek
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Karen S Chessa
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Girish S Shirali
- The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Arni Nutting
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - G Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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Kobayashi Y, Sudini NL, Rhee JW, Aymami M, Moneghetti KJ, Bouajila S, Kobayashi Y, Kim JB, Schnittger I, Teuteberg JJ, Khush KK, Fearon WF, Haddad F. Incremental Value of Deformation Imaging and Hemodynamics Following Heart Transplantation. JACC-HEART FAILURE 2017; 5:930-939. [DOI: 10.1016/j.jchf.2017.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
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Abstract
We report the case of a 37-year-old woman with acute respiratory distress syndrome and became a candidate for organ donation after anoxic brain injury and was on a venovenous extracorporeal membrane oxygenation (VV-ECMO) support. On preoperative evaluation and gross examination, the donor's heart was acceptable for heart transplantation to a 62-year-old female patient with a history of nonischemic cardiomyopathy with a HeartMate II mechanical assist device. Orthotopic heart transplantation was successfully performed in the recipient. We report a case that suggests that the procurement of a heart from a donor on ECMO support can potentially expand the donor heart pool in carefully selected patients.
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López-Sainz Á, Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, Paniagua-Martin MJ, Seoane-Quiroga L, Iglesias-Gil C, Herrera-Noreña JM, Cuenca-Castillo JJ, Vázquez-Rodríguez JM, Crespo-Leiro MG. Late graft failure in heart transplant recipients: incidence, risk factors and clinical outcomes. Eur J Heart Fail 2017; 20:385-394. [DOI: 10.1002/ejhf.886] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/27/2017] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carmen Iglesias-Gil
- Servicio de Cirugía Cardiaca; Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); La Coruna Spain
| | - José M. Herrera-Noreña
- Servicio de Cirugía Cardiaca; Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); La Coruna Spain
| | - José J. Cuenca-Castillo
- Servicio de Cirugía Cardiaca; Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); La Coruna Spain
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Abstract
Hypertension is a common complication among post cardiac transplant recipients affecting more than 95% of patients. Increased blood pressure poses a significant cardiovascular morbidity and mortality in these patients; it should be identified quickly and needs to be managed appropriately. Understanding the pathophysiology and contributing factors to this disease in these complex and unique patients is the key to appropriate treatment selection.
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Affiliation(s)
- Amanda L Bennett
- Department of Internal Medicine, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Hector O Ventura
- Department of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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Chowdhury SM, Goudar SP, Baker GH, Taylor CL, Shirali GS, Friedberg MK, Dragulescu A, Chessa KS, Mertens L. Speckle-Tracking Echocardiographic Measures of Right Ventricular Diastolic Function Correlate with Reference Standard Measures Before and After Preload Alteration in Children. Pediatr Cardiol 2017; 38:27-35. [PMID: 27655413 PMCID: PMC5288273 DOI: 10.1007/s00246-016-1479-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/15/2016] [Indexed: 01/19/2023]
Abstract
The accuracy of echocardiographic measures of right ventricular (RV) diastolic function has been sparsely studied. Our objective was to evaluate the correlation between echocardiographic and reference standard measures of RV diastolic function derived from micromanometer pressure analysis before and after preload alteration in children. Echocardiograms and micromanometer pressure analyses were prospectively performed before and after fluid bolus in children undergoing right heart catheterization. The isovolumic relaxation time constant (τ) and end-diastolic pressure (EDP) were measured. Conventional and speckle-tracking echocardiographic (STE) parameters of RV systolic and diastolic function were assessed. Normal saline bolus was given to increase RV EDP by 20 %. Twenty-eight studies were performed in 22 patients with congenital heart disease or postheart transplantation. Mean age was 8.7 ± 6.1 years. RV longitudinal early diastolic strain rate (EDSR) correlated with τ before (r = 0.57, p = 0.001) and after fluid bolus (r = 0.48, p = 0.008). No conventional echocardiographic measures correlated with τ both before and after fluid bolus. Multiple regression analysis revealed RV EDSR and LV circumferential EDSR as independent predictors of RV τ. There were no independent predictors of EDP. RV EDSR appears to correlate with the reference standard measure of early active ventricular relaxation in children at baseline and after changes in preload. Conventional echocardiographic measures of diastolic function were not predictive of diastolic function after preload alteration. Future studies should assess the prognostic significance of STE measures of diastolic function in this population.
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Affiliation(s)
- Shahryar M. Chowdhury
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Suma P. Goudar
- The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, Missouri
| | - G. Hamilton Baker
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L. Taylor
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Girish S. Shirali
- The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, Missouri
| | - Mark K. Friedberg
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen S. Chessa
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Luc Mertens
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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Ambrosi P, Macé L, Habib G. Predictive value of E/A and E/E′ Doppler indexes for cardiac events in heart transplant recipients. Clin Transplant 2016; 30:959-63. [DOI: 10.1111/ctr.12772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Pierre Ambrosi
- Department of Cardiology; La Timone Hospital; Aix-Marseille University; Marseille France
| | - Loic Macé
- Department of Cardiac Surgery; La Timone Hospital; Aix-Marseille University; Marseille France
| | - Gilbert Habib
- Department of Cardiology; La Timone Hospital; Aix-Marseille University; Marseille France
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Broch K, Al-Ani A, Gude E, Gullestad L, Aakhus S. Echocardiographic evaluation of left ventricular filling pressure in heart transplant recipients. SCAND CARDIOVASC J 2015; 48:349-56. [PMID: 25414078 DOI: 10.3109/14017431.2014.981579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Diastolic dysfunction is a major cause of morbidity in heart transplant recipients. A reliable, non-invasive marker of left ventricular (LV) filling pressure would simplify follow-up in these patients. We aimed to test the validity of echocardiographic indices of LV filling pressure in a contemporary population of heart transplant recipients. DESIGN Eighty-three patients were examined by right-sided heart catheterisation and echocardiography one year after heart transplantation. We explored the association between echocardiographic parameters of LV filling pressure and invasively measured pulmonary capillary wedge pressure (PCWP). RESULTS Peak early mitral flow velocity divided by septal early mitral relaxation velocity (E/e'(septal)) was the echocardiographic parameter that best correlated with PCWP (r = 0.47; p < 0.001). At a cut-off value of 22, E/e'(septal) could identify patients with a PCWP above 12 mm Hg with a sensitivity of 56% and a specificity of 95%. CONCLUSIONS The E/e' index was moderately associated with LV filling pressure in heart transplant recipients. Echocardiographic parameters of diastolic function should be interpreted with caution when estimating left ventricular filling pressures in this population.
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Affiliation(s)
- Kaspar Broch
- Department of Cardiology, Oslo University Hospital , Rikshospitalet, Oslo , Norway
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30
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Seguchi O, Fujita T, Murata Y, Sunami H, Sato T, Watanabe T, Nakajima S, Kuroda K, Hisamatsu E, Sato T, Yanase M, Hata H, Wada K, Ishibashi-Ueda H, Kobayashi J, Nakatani T. Incidence, etiology, and outcome of primary graft dysfunction in adult heart transplant recipients: a single-center experience in Japan. Heart Vessels 2015; 31:555-62. [DOI: 10.1007/s00380-015-0649-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/06/2015] [Indexed: 01/29/2023]
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Ambrosi P, Kreitmann B, Fromonot J, Habib G, Guieu R. Plasma Ultrasensitive Cardiac Troponin During Long-Term Follow-up of Heart Transplant Recipients. J Card Fail 2015; 21:103-7. [DOI: 10.1016/j.cardfail.2014.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/18/2014] [Accepted: 10/27/2014] [Indexed: 12/30/2022]
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Bech-Hanssen O, Al-Habeeb W, Ahmed W, Di Salvo G, Pergola V, Al-Admawi M, Al-Amri M, Al-Shahid M, Al-Buraiki J, Fadel BM. Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients. Echocardiography 2014; 32:411-9. [DOI: 10.1111/echo.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Odd Bech-Hanssen
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Waleed Al-Habeeb
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
- King Saud University; Riyadh Kingdom of Saudi Arabia
| | - Waqas Ahmed
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Giovanni Di Salvo
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Valeria Pergola
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Mohammed Al-Admawi
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Mohammed Al-Amri
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Maie Al-Shahid
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Jehad Al-Buraiki
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
| | - Bahaa M. Fadel
- Heart Center; King Faisal Specialist Hospital & Research Center; Riyadh Kingdom of Saudi Arabia
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Diffuse Myocardial Fibrosis Evaluated by Post-Contrast T1 Mapping Correlates With Left Ventricular Stiffness. J Am Coll Cardiol 2014; 63:1112-8. [DOI: 10.1016/j.jacc.2013.10.084] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/17/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
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Prins K, Masri C, Colvin-Adams M, Eckman P. Characterization of 25+ year survivors of cardiac transplantation. J Heart Lung Transplant 2013; 32:560-2. [PMID: 23453571 DOI: 10.1016/j.healun.2013.01.1053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 01/27/2013] [Accepted: 01/29/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kurt Prins
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
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37
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Giovanardi P, Tincani E, Rossi R, Agnoletto V, Bondi M, Modena MG. Right ventricular function predicts cardiovascular events in outpatients with stable cardiovascular diseases: preliminary results. Intern Emerg Med 2012; 7:251-6. [PMID: 21290200 DOI: 10.1007/s11739-011-0508-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 01/05/2011] [Indexed: 11/28/2022]
Abstract
Right ventricular (RV) function impacts the outcome in cardiac and pulmonary diseases such as heart failure, pulmonary hypertension, myocardial infarction, valvular, and congenital heart diseases. To our knowledge, simultaneous evaluation of left ventricular (LV) and RV systolic and diastolic echocardiographic indices in outpatients with clinically stable cardiovascular diseases has never been performed. Thus, we designed a prospective cohort study to define the prognostic power of these parameters. One hundred and sixty-three patients were submitted to transthoracic echocardiography with multiparametric and tissue Doppler evaluation of the following indices: ejection fraction, MAPSE, TAPSE, RV presystolic peak, LV and RV diastolic function, pulmonary artery systolic pressure, and functional mitral regurgitation. All these parameters and clinical variables (age, sex, and prior cardiovascular events) were entered in a multivariable Cox regression model. The primary end point was the occurrence of major cardiovascular events (MACEs) during the follow-up period. Twenty-one MACEs were observed; in the final multivariable Cox regression model only prior cardiovascular events (B 1.305, p 0.004, 95% CI 1.523-8.933), age (B 0.067, p 0.005, 95% CI 1.020-1.121), and TAPSE (B -1.065, p 0.026, 95% CI 0.135-0.883) were associated with MACEs. TAPSE, a simple and reproducible echocardiographic index, may be viewed as an early echocardiographic marker of heart involvement in atherosclerosis. We believe that TAPSE may be useful in clinical practice for risk stratification.
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Affiliation(s)
- Paolo Giovanardi
- Unità Operativa di Medicina Interna ad indirizzo Cardiovascolare, Nuovo Ospedale S. Agostino-Estense, Baggiovara, Modena, Italy.
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Berman M, Ali A, Ashley E, Freed D, Clarke K, Tsui S, Parameshwar J, Large S. Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death? J Heart Lung Transplant 2010; 29:957-65. [DOI: 10.1016/j.healun.2010.04.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 03/28/2010] [Accepted: 04/07/2010] [Indexed: 12/19/2022] Open
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Arora S, Aukrust P, Ueland T, Broch K, Simonsen S, Gude E, Fiane AE, Geiran O, Wergeland R, Andreassen AK, Gullestad L. Elevated serum uric acid levels following heart transplantation predict all-cause and cardiac mortality. Eur J Heart Fail 2009; 11:1005-13. [PMID: 19737803 DOI: 10.1093/eurjhf/hfp115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIMS We evaluated the relationship between elevated serum uric acid (SUA) and mortality as well as cardiac allograft vasculopathy (CAV) among 184 heart transplant (HTx) recipients. We also measured inflammatory, neurohormonal, and oxidative stress markers to explore pathophysiological mechanisms. METHODS AND RESULTS There were 28 (15%) deaths, patients with SUA > or = 502 micromol/L (upper quartile) at 1 year post-HTx had an increased risk of total mortality (adjusted HR 2.21, P = 0.03) and cardiac mortality (adjusted HR 4.38, P = 0.03). Elevated SUA was a significant risk factor for development of moderate/severe angiographic CAV (adjusted HR 4.79, P = 0.01). A smaller decline in SUA (<97 micromol/L) during the first year post-HTx was also associated with an increased risk of mortality (P = 0.02). Patients with elevated SUA had significantly higher levels of high-sensitivity C-reactive protein (P = 0.008) and N-terminal probrain natriuretic peptide (P = 0.022), but there was no significant difference in oxidative stress parameters. CONCLUSION Elevated SUA at 1 year post-HTx, or a modest rather than a marked decline in SUA levels during the first year post-HTx, is associated with an increased risk of mortality. Although the pathophysiological mechanism is unclear, our data indicate a potential relationship between SUA and inflammation which should be explored further.
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Affiliation(s)
- Satish Arora
- Department of Cardiology, Rikshospitalet Medical Centre, N-0027 Oslo, Norway.
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40
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Emergency Department Presentation of Heart Transplant Recipients with Acute Heart Failure. Heart Fail Clin 2009; 5:129-43, viii. [DOI: 10.1016/j.hfc.2008.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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41
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Scott JM, Esch BTA, Haykowsky MJ, Warburton DER, Toma M, Jelani A, Taylor D, Paterson I, Poppe D, Liang Y, Thompson R. Cardiovascular responses to incremental and sustained submaximal exercise in heart transplant recipients. Am J Physiol Heart Circ Physiol 2008; 296:H350-8. [PMID: 19060120 DOI: 10.1152/ajpheart.01100.2008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The cardiovascular response to exercise in heart transplant recipients (HTR) has been compared with that of healthy individuals matched to the recipient age (RM controls). However, no study has compared HTR with donor age-matched (DM) controls. Moreover, the cardiovascular response to sustained submaximal exercise in HTR requires further evaluation. We therefore examined cardiovascular responses during incremental exercise and sustained (1 h) submaximal aerobic exercise in 9 clinically stable HTR [63 +/- 10 yr of age, 24.2 +/- 10.9 ml x kg(-1) x min(-1) peak O(2) uptake (Vo(2peak))] and 11 healthy age-matched controls (60 +/- 11 yr of age and 36.3 +/- 10.7 ml.kg(-1) x min(-1) Vo(2peak) for 6 RM controls and 35 +/- 8 yr of age and 51.1 +/- 10.4 ml x kg(-1) x min(-1) Vo(2peak) for 5 DM controls). Heart rate (HR) and left ventricular systolic and diastolic volumes (2-dimensional echocardiography) indexed to body surface area [end-systolic and end-diastolic volume indexes (EDVI and ESVI)], cardiac output (CI), ejection fraction (EF), systemic vascular resistance (SVRI), end-systolic elastance index, and arterial elastance index were determined. Although systolic function was maintained during incremental exercise, peak CI was significantly reduced (6.7 +/- 2.4 vs. 11.6 +/- 1.4 l x min(-1) x m(-2)), secondary to blunted HR, EDVI, and increased peak SVRI, in HTR compared with DM controls. The lower peak CI in HTR than in RM controls was due to blunted peak EDVI (54.1 +/- 13.2 vs. 68.6 +/- 5.7 ml/m(2)). During sustained submaximal exercise, HTR exhausted their preload reserve, a response for which changes in ESVI, HR, or EF did not fully compensate. Thus it appears that HTR are limited by impaired preload reserve, HR reserve, and vascular reserve during exercise conditions.
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Affiliation(s)
- Jessica M Scott
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC, Canada.
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