Faculty Collaboration Database

Improved Detection of Cardiac Allograft Vasculopathy: A Multi-Institutional Analysis of Functional Parameters in Pediatric Heart Transplant Recipients. J Am Coll Cardiol 2015 Aug 04;66(5):547-57

Date

08/01/2015

Pubmed ID

26227194

DOI

10.1016/j.jacc.2015.05.063

Scopus ID

2-s2.0-84938096277 (requires institutional sign-in at Scopus site)   57 Citations

Abstract

BACKGROUND: Recent guidelines recommend assessment of systolic function and filling pressures to augment angiographic grading of cardiac allograft vasculopathy (CAV); however, no data exist on the utility of these guidelines.

OBJECTIVES: The aims of this study were to evaluate whether the assessment of systolic and diastolic graft function, in addition to angiography, improves recognition of patients at high risk of graft loss and to assess the ability of adult filling-pressure thresholds to discriminate graft dysfunction in pediatric patients.

METHODS: This study reviewed Pediatric Heart Transplant Study data from 1993 to 2009. Graft dysfunction was defined as significant systolic dysfunction (ejection fraction [EF] <45%) or the presence of restrictive hemodynamic features. Additional pediatric hemodynamic cutpoints of right atrial pressure (RAP) >12 mm Hg or pulmonary capillary wedge pressure (PCWP) >15 mm Hg were analyzed.

RESULTS: In the study, 8,122 angiograms were performed in 3,120 patients, and 70% of patients had at least 1 angiogram. Angiographic incidence of CAV was 5%, 15%, and 28% at 2, 5, and 10 years, respectively, and most disease was mild. The presence of graft dysfunction identified patients at greater risk for graft loss even in children with mild angiographic vasculopathy (p < 0.0001). An RAP >12 mm Hg or a PCWP >15 mm Hg was sufficient to detect patients at high risk of graft loss even with mild angiographic disease.

CONCLUSIONS: Patients with only mild angiographic CAV have significantly better outcomes than do patients with moderate or severe disease. The presence of an EF <45%, an RAP >12 mm Hg, or a PCWP >15 mm Hg identifies children at increased risk of graft loss even in the presence of only mild angiographic vasculopathy.

Author List

Kindel SJ, Law YM, Chin C, Burch M, Kirklin JK, Naftel DC, Pruitt E, Carboni MP, Arens A, Atz AM, Dreyer WJ, Mahle WT, Pahl E

Author

Steven J. Kindel MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Allografts
Atrial Function, Right
Child
Child, Preschool
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Female
Graft Rejection
Heart Transplantation
Hemodynamics
Humans
Infant
Kaplan-Meier Estimate
Male
Pulmonary Wedge Pressure
Retrospective Studies
Risk Assessment
Severity of Illness Index
United Kingdom
United States
Vascular Patency