Improved Detection of Cardiac Allograft Vasculopathy A Multi-Institutional Analysis of Functional Parameters in Pediatric Heart Transplant Recipients

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:66

Article

Kindel, Steven J.¹  Law, Yuk M.²  Chin, Clifford³  Burch, Michael⁴  Kirklin, James K.⁵  Naftel, David C.⁵  Pruitt, Elizabeth⁵  Carboni, Michael P.⁶  Arens, Anna⁷  Atz, Andrew M.⁸  Dreyer, William J.⁹  Mahle, William T.¹⁰  Pahl, Elfriede⁷ 

[1] Univ Nebraska, Childrens Hosp & Med Ctr, Dept Pediat, Omaha, NE 68182 USA

[2] Univ Washington, Childrens Hosp & Reg Med Ctr, Dept Pediat, Seattle, WA 98195 USA

[3] Univ Cincinnati, Cincinnati Childrens Hosp & Med Ctr, Dept Pediat, Cincinnati, OH USA

[4] Great Ormond St Hosp Sick Children, Dept Pediat, London, England

[5] Univ Alabama Birmingham, Dept Surg, Birmingham, AL USA

[6] Duke Childrens Hosp, Dept Pediat, Durham, NC USA

[7] Northwestern Univ, Ann & Robert H Lurie Childrens Hosp Chicago, Dept Pediat, Chicago, IL 60611 USA

[8] Med Univ S Carolina, Dept Pediat, Charleston, SC 29425 USA

[9] Baylor Coll Med, Texas Childrens Hosp, Dept Pediat, Houston, TX 77030 USA

[10] Emory Univ, Sch Med, Childrens Hlth Care Atlanta, Sibley Heart Ctr,Dept Pediat, Atlanta, GA USA

关键词: chronic rejection;    coronary artery;    graft loss;    heart transplant;    hemodynamics;    vasculopathy;   

DOI  :  10.1016/j.jacc.2015.05.063

来源: Elsevier

【 摘 要 】

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. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

Free