Association of pediatric heart transplant coronary vasculopathy with abnormal hemodynamic measures.

Abstract

OBJECTIVE:

Transplant coronary artery disease (TCAD) is the limiting factor to long-term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter-derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients. DESIGN, PATIENTS, OUTCOME MEASURES: Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheter-derived right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.

RESULTS:

TCAD was diagnosed an average of 8.3 years post-HTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheter-derived pressure measurements showed that RVEDP was elevated in TCAD compared with non-TCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10 mm Hg or PCWP > 12 mm Hg was associated with TCAD (OR = 5.2; P= .010).

CONCLUSIONS:

In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.

• Authors: Ranjit Aiyagari, Melisa Nika, James G Gurney, Janet E Donohue, Mary C Zamberlan, Karen King, Dennis C Crowley, Robert J Gajarski
• Journal: Congenital heart disease (Congenit Heart Dis) 2011 Mar-Apr Vol. 6 Issue 2 Pg. 128-33 ISSN: 1747-0803 [Electronic] United States
• PMID: 21426526 (Publication Type: Journal Article)
• Copyright: © 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

Topics

• Adolescent
• Biopsy
• Cardiac Catheterization
• Child
• Child, Preschool
• Coronary Angiography
• Coronary Artery Disease (diagnosis, etiology, mortality, physiopathology, surgery)
• Graft Survival
• Heart Transplantation (adverse effects, mortality)
• Hemodynamics
• Humans
• Logistic Models
• Michigan
• Pulmonary Wedge Pressure
• Reoperation
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Ventricular Function, Left
• Ventricular Function, Right
• Ventricular Pressure
• Young Adult