TY - JOUR
T1 - Abnormal Myocardial Contractility After Pediatric Heart Transplantation by Cardiac MRI
AU - Grotenhuis, Heynric B.
AU - Nyns, Emile C.A.
AU - Kantor, Paul F.
AU - Dipchand, Anne I.
AU - Greenway, Steven C.
AU - Yoo, Shi Joon
AU - Tomlinson, George
AU - Chaturvedi, Rajiv R.
AU - Grosse-Wortmann, Lars
N1 - Publisher Copyright:
© 2017, The Author(s).
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Acute cellular rejection (ACR) compromises graft function after heart transplantation (HTX). The purpose of this study was to describe systolic myocardial deformation in pediatric HTX and to determine whether it is impaired during ACR. Eighteen combined cardiac magnetic resonance imaging (CMR)/endomyocardial biopsy (EMBx) examinations were performed in 14 HTX patients (11 male, age 13.9 ± 4.7 years; 1.2 ± 1.3 years after HTX). Biventricular function and left ventricular (LV) circumferential strain, rotation, and torsion by myocardial tagging CMR were compared to 11 controls as well as between patients with and without clinically significant ACR. HTX patients showed mildly reduced biventricular systolic function when compared to controls [LV ejection fraction (EF): 55 ± 8% vs. 61 ± 3, p = 0.02; right ventricular (RV) EF: 48 ± 7% vs. 53 ± 6, p = 0.04]. Indexed LV mass was mildly increased in HTX patients (67 ± 14 g/m2 vs. 55 ± 13, p = 0.03). LV myocardial deformation indices were all significantly reduced, expressed by global circumferential strain (−13.5 ± 2.3% vs. −19.1 ± 1.1%, p < 0.01), basal strain (−13.7 ± 3.0% vs. −17.5 ± 2.4%, p < 0.01), mid-ventricular strain (−13.4 ± 2.7% vs. −19.3 ± 2.2%, p < 0.01), apical strain (−13.5 ± 2.8% vs. −19.9 ± 2.0%, p < 0.01), basal rotation (−2.0 ± 2.1° vs. −5.0 ± 2.0°, p < 0.01), and torsion (6.1 ± 1.7° vs. 7.8 ± 1.1°, p < 0.01). EMBx demonstrated ACR grade 0 R in 3 HTX cases, ACR grade 1 R in 11 HTX cases and ACR grade 2 R in 4 HTX cases. When comparing clinically non-significant ACR (grades 0–1 R vs. ACR 2 R), basal rotation, and apical rotation were worse in ACR 2 R patients (−1.4 ± 1.8° vs. −4.2 ± 1.4°, p = 0.01 and 10.2 ± 2.9° vs. 2.8 ± 1.9°, p < 0.01, respectively). Pediatric HTX recipients demonstrate reduced biventricular systolic function and decreased myocardial contractility. Myocardial deformation indices by CMR may serve as non-invasive markers of graft function and, perhaps, rejection in pediatric HTX patients.
AB - Acute cellular rejection (ACR) compromises graft function after heart transplantation (HTX). The purpose of this study was to describe systolic myocardial deformation in pediatric HTX and to determine whether it is impaired during ACR. Eighteen combined cardiac magnetic resonance imaging (CMR)/endomyocardial biopsy (EMBx) examinations were performed in 14 HTX patients (11 male, age 13.9 ± 4.7 years; 1.2 ± 1.3 years after HTX). Biventricular function and left ventricular (LV) circumferential strain, rotation, and torsion by myocardial tagging CMR were compared to 11 controls as well as between patients with and without clinically significant ACR. HTX patients showed mildly reduced biventricular systolic function when compared to controls [LV ejection fraction (EF): 55 ± 8% vs. 61 ± 3, p = 0.02; right ventricular (RV) EF: 48 ± 7% vs. 53 ± 6, p = 0.04]. Indexed LV mass was mildly increased in HTX patients (67 ± 14 g/m2 vs. 55 ± 13, p = 0.03). LV myocardial deformation indices were all significantly reduced, expressed by global circumferential strain (−13.5 ± 2.3% vs. −19.1 ± 1.1%, p < 0.01), basal strain (−13.7 ± 3.0% vs. −17.5 ± 2.4%, p < 0.01), mid-ventricular strain (−13.4 ± 2.7% vs. −19.3 ± 2.2%, p < 0.01), apical strain (−13.5 ± 2.8% vs. −19.9 ± 2.0%, p < 0.01), basal rotation (−2.0 ± 2.1° vs. −5.0 ± 2.0°, p < 0.01), and torsion (6.1 ± 1.7° vs. 7.8 ± 1.1°, p < 0.01). EMBx demonstrated ACR grade 0 R in 3 HTX cases, ACR grade 1 R in 11 HTX cases and ACR grade 2 R in 4 HTX cases. When comparing clinically non-significant ACR (grades 0–1 R vs. ACR 2 R), basal rotation, and apical rotation were worse in ACR 2 R patients (−1.4 ± 1.8° vs. −4.2 ± 1.4°, p = 0.01 and 10.2 ± 2.9° vs. 2.8 ± 1.9°, p < 0.01, respectively). Pediatric HTX recipients demonstrate reduced biventricular systolic function and decreased myocardial contractility. Myocardial deformation indices by CMR may serve as non-invasive markers of graft function and, perhaps, rejection in pediatric HTX patients.
KW - Acute cellular rejection
KW - Heart transplant
KW - Magnetic resonance imaging
KW - Myocardial deformation
KW - Pediatric
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U2 - 10.1007/s00246-017-1642-5
DO - 10.1007/s00246-017-1642-5
M3 - Article
C2 - 28555404
AN - SCOPUS:85019772456
SN - 0172-0643
VL - 38
SP - 1198
EP - 1205
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 6
ER -