TY - JOUR
T1 - Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients
T2 - A Pilot Study
AU - Chowdhury, Shahryar M.
AU - Butts, Ryan J.
AU - Hlavacek, Anthony M.
AU - Taylor, Carolyn L.
AU - Chessa, Karen S.
AU - Bandisode, Varsha M.
AU - Shirali, Girish S.
AU - Nutting, Arni
AU - Baker, G. Hamilton
N1 - Publisher Copyright:
© 2017 American Society of Echocardiography
PY - 2018/3
Y1 - 2018/3
N2 - 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.
AB - 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.
KW - Diastolic function
KW - Echocardiography
KW - Pediatric
KW - Pressure-volume relationship
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U2 - 10.1016/j.echo.2017.11.010
DO - 10.1016/j.echo.2017.11.010
M3 - Article
C2 - 29246510
AN - SCOPUS:85037730226
SN - 0894-7317
VL - 31
SP - 342-348.e1
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 3
ER -