Wisotzkey Bethany L, Haileselassie Bereketeab, Jorgensen Neal, Albers Erin L, Kemna Mariksa S, Soriano Brian D, Bhat Aarti H, Kronmal Richard A, Bouccek Robert J, Law Yuk M
Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA.
Pediatric Critical Care Medicine, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, CA, USA.
Cardiol Young. 2022 Apr;32(4):531-538. doi: 10.1017/S104795112100247X. Epub 2021 Jun 24.
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.
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.
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.
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.
对小儿心脏移植受者同种异体移植物舒张功能进行纵向评估，对于早期发现急性排斥反应、心脏同种异体血管病变和移植物功能障碍至关重要。导管插入术测得的平均舒张期右心房压和肺毛细血管楔压是评估的参考标准。超声心动图检查是非侵入性的，更适合进行系列监测，但各项参数缺乏准确性。本研究旨在确定移植后平均右心房压和肺毛细血管楔压的协变量，包括B型利钠肽和某些超声心动图参数。
对2007年至2011年接受移植的56例小儿受者的143次计划心脏导管插入术和超声心动图检查进行回顾性分析。排除有排斥反应的样本。将使用向后选择的单变量和多变量线性回归模型应用于由B型利钠肽、血流动力学和超声心动图数据组成的数据库。
Ln B型利钠肽、心率z评分、左心室舒张末期内径z评分、二尖瓣E/e'以及收缩期室间隔增厚百分比与平均右心房压独立相关。Ln B型利钠肽、心率z评分、左心室舒张末期内径z评分、左心室质量（实测/预测）以及二尖瓣E/e'与平均肺毛细血管楔压独立相关。B型利钠肽的协变量包括平均肺动脉压和肺毛细血管楔压、身高、血红蛋白、缩短分数、收缩期室间隔增厚百分比以及肺血管阻力指数。
在无排斥反应的小儿心脏移植受者中，B型利钠肽和舒张功能的超声心动图指标与移植后平均右心房压和肺毛细血管楔压独立相关。
