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Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type natriuretic peptide

Published online by Cambridge University Press:  24 June 2021

Bethany L. Wisotzkey Open the ORCID record for Bethany L. Wisotzkey [Opens in a new window] ,
Bereketeab Haileselassie ,
Neal Jorgensen ,
Erin L. Albers ,
Mariksa S. Kemna ,
Brian D. Soriano ,
Aarti H. Bhat ,
Richard A. Kronmal ,
Robert J. Bouccek  and
Yuk M. Law Open the ORCID record for Yuk M. Law [Opens in a new window]
Bethany L. Wisotzkey*
Affiliation:
Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
Bereketeab Haileselassie
Affiliation:
Pediatric Critical Care Medicine, Lucile Salter Packard Children’s Hospital at Stanford, Palo Alto, CA, USA
Neal Jorgensen
Affiliation:
Department of Biostatistics, University of Washington, Seattle, WA, USA
Erin L. Albers
Affiliation:
Pediatric Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
Mariksa S. Kemna
Affiliation:
Pediatric Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
Brian D. Soriano
Affiliation:
Pediatric Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
Aarti H. Bhat
Affiliation:
Pediatric Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
Richard A. Kronmal
Affiliation:
Department of Biostatistics, University of Washington, Seattle, WA, USA
Robert J. Bouccek
Affiliation:
Research Affiliate, Seattle Children’s Research Institute, Seattle, WA, USA
Yuk M. Law
Affiliation:
Pediatric Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
*
Author for correspondence: Dr B. L. Wisotzkey, MD, Pediatric Cardiology, Phoenix Children’s Hospital, 1919 E. Thomas Rd, Main Tower, Phoenix, AZ85016, USA. Tel: +602 933 2311. E-mail: bwisotzkey@phoenixchildrens.com
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Abstract

Background:

Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters.

Methods:

A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data.

Results:

Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e’, and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e’ were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index.

Conclusions:

B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.

Keywords

Paediatric heart transplantfilling pressuresechocardiographyB-type natriuretic peptide
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 4 , April 2022 , pp. 531 - 538
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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