Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study

Overview

Journal J Am Soc Echocardiogr

Specialty Radiology

Date 2017 Dec 17

PMID 29246510

Citations 8

Authors

Shahryar M Chowdhury

Ryan J Butts

Anthony M Hlavacek

Carolyn L Taylor

Karen S Chessa

Varsha M Bandisode

Girish S Shirali

Arni Nutting

G Hamilton Baker

Affiliations

Soon will be listed here.

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). A lateral E:e'/EDV of >0.15 mL 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.

Citing Articles

Low Ventricular Stiffness Is Associated With Suboptimal Outcomes in Patients With a Single Right Ventricle After the Fontan Operation: A Novel Phenotype.

Chowdhury S, Atz A, Graham E, Bandisode V, Rhodes J, Nutting A J Am Heart Assoc. 2024; 13(17):e035601.

PMID: 39189484 PMC: 11646499. DOI: 10.1161/JAHA.124.035601.

Clinical Applications of Pressure-Volume Assessment in Congenital Heart Disease.

Hiremath G, Batlivala S, Callahan R, Thatte N, Rockefeller T, Nawaytou H J Soc Cardiovasc Angiogr Interv. 2024; 2(3):100599.

PMID: 39130717 PMC: 11307813. DOI: 10.1016/j.jscai.2023.100599.

Non-invasive myocardial tissue deformation and discoordination indices predict cardiac allograft vasculopathy in pediatric heart transplantation patients.

Schafer M, Miyamoto S, Jaggers J, Everitt M, Von Alvensleben J, Campbell D Int J Cardiovasc Imaging. 2024; 40(7):1565-1574.

PMID: 38780709 DOI: 10.1007/s10554-024-03143-6.

Evaluation of the relationship between left atrial stiffness, left ventricular stiffness, and left atrioventricular coupling index in type 2 diabetes patients: a speckle tracking echocardiography study.

Nguyen Ngoc Dang H, Viet Luong T, Anh Ho B Front Cardiovasc Med. 2024; 11:1372181.

PMID: 38737712 PMC: 11084270. DOI: 10.3389/fcvm.2024.1372181.

Heart Failure with Preserved Ejection Fraction in Children.

Das B, Deshpande S, Akam-Venkata J, Shakti D, Moskowitz W, Lipshultz S Pediatr Cardiol. 2022; 44(3):513-529.

PMID: 35978175 DOI: 10.1007/s00246-022-02960-7.

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