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

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

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 stiffnes...

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Veröffentlicht in:Journal of the American Society of Echocardiography 2018-03, Vol.31 (3), p.342-348.e1
Hauptverfasser: Chowdhury, Shahryar M., Butts, Ryan J., Hlavacek, Anthony M., Taylor, Carolyn L., Chessa, Karen S., Bandisode, Varsha M., Shirali, Girish S., Nutting, Arni, Baker, G. Hamilton
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Diastolic function
Echocardiography
Pediatric
Pressure-volume relationship
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container_end_page 348.e1
container_issue 3
container_start_page 342
container_title Journal of the American Society of Echocardiography
container_volume 31
creator Chowdhury, Shahryar M.
Butts, Ryan J.
Hlavacek, Anthony M.
Taylor, Carolyn L.
Chessa, Karen S.
Bandisode, Varsha M.
Shirali, Girish S.
Nutting, Arni
Baker, G. Hamilton
description 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. 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. 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 
doi_str_mv 10.1016/j.echo.2017.11.010
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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. 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 &lt; .01), septal E:e′/EDV (r = 0.57, P &lt; .01), and (E:circumferential early diastolic strain rate)/EDV (r = 0.54, P &lt; .01) correlated with β. Lateral E:e′/EDV displayed a C statistic of 0.93 in detecting patients with abnormal LV stiffness (β &gt; 0.015 mL−1). A lateral E:e′/EDV of &gt;0.15 mL−1 had 89% sensitivity and 93% specificity in detecting an abnormal β. Echocardiographic estimates of ventricular stiffness may be accurate compared with the gold standard in pediatric heart transplant recipients. 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Hamilton</creatorcontrib><title>Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>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. 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. 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A lateral E:e′/EDV of &gt;0.15 mL−1 had 89% sensitivity and 93% specificity in detecting an abnormal β. Echocardiographic estimates of ventricular stiffness may be accurate compared with the gold standard in pediatric heart transplant recipients. 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Hamilton</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>31</volume><issue>3</issue><spage>342</spage><epage>348.e1</epage><pages>342-348.e1</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>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. 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. 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). 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The clinical usefulness of these noninvasive measures in assessing LV stiffness merits further study in children. •The objective was to validate echocardiographic measures of left ventricular stiffness.•Noninvasive and invasive estimations of stiffness correlated well in children.•These measures appear promising and merit further study in children.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29246510</pmid><doi>10.1016/j.echo.2017.11.010</doi><oa>free_for_read</oa></addata></record>
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subjects Diastolic function
Echocardiography
Pediatric
Pressure-volume relationship
title Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study
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