Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
Echocardiography. 2024 Feb;41(2):e15771. doi: 10.1111/echo.15771.
Pediatric heart transplant (HT) has become the standard of care for end-stage heart failure in children worldwide. Serial echocardiographic evaluations of graft anatomy and function during follow-up are crucial for post-HT management. However, evolution of cardiac structure and function after pediatric HT has not been well described, especially during first year post-HT. This study aimed to characterize the evolution of cardiac structure and function after pediatric HT and investigate the correlation between biventricular function with adverse clinical outcomes.
A single-center retrospective study of echocardiographic data obtained among 99 pediatric HT patients was conducted. Comprehensive echocardiographic examination was performed in all patients at 1-, 3-, 6-, 9- and 12-months post-HT. We obtained structural, functional and hemodynamic parameters from both left- and right-side heart, such as left ventricular stroke volume (LVSV), left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), etc. The cardiac evolution of pediatric HT patients during first post-HT year was described and compared between different time points. We also explored the correlation between cardiac function and major adverse transplant events (MATEs).
Gradual improvement of LV and RV function was seen in pediatric HT patients within the first year. Biventricular function parameters associated with MATEs. The results of this study pave way for designing larger and longer follow-up of this population, potentially aiming at using multiparameter echocardiographic prediction of adverse events.
儿科心脏移植（HT）已成为全球治疗终末期心力衰竭儿童的标准治疗方法。在随访期间对移植物解剖结构和功能进行连续超声心动图评估对于 HT 后的管理至关重要。然而，儿科 HT 后心脏结构和功能的演变尚未得到很好的描述，尤其是在 HT 后第一年。本研究旨在描述儿科 HT 后心脏结构和功能的演变，并探讨双心室功能与不良临床结局的相关性。
对 99 例儿科 HT 患者的超声心动图数据进行了单中心回顾性研究。所有患者在 HT 后 1、3、6、9 和 12 个月进行全面超声心动图检查。我们从左、右心获得了结构、功能和血流动力学参数，如左心室每搏量（LVSV）、左心室射血分数（LVEF）、右心室分数面积变化（RVFAC）等。描述了儿科 HT 患者在 HT 后第一年的心脏演变，并比较了不同时间点之间的差异。我们还探讨了心脏功能与主要不良移植事件（MATEs）之间的相关性。
1）左心参数的演变：左心房长度、二尖瓣 E 速度、E/A 比值、LVSV 和 LVEF 在 HT 后第一年显著增加，而二尖瓣 A 速度显著降低（P<.05）。与 HT 后 1 个月相比，3 个月时室间隔（IVS）和左心室后壁（LVPW）减小，但随后增加。2）右心参数的演变：右心室基底直径和中间直径；右心室长径、三尖瓣 E 速度、E/A 比值、三尖瓣瓣环平面收缩期运动速度 e'游离壁和 RVFAC 增加，而三尖瓣 A 速度降低（P<.05）。3）单变量逻辑回归模型表明，HT 后 1 年的双心室功能参数（LVEF、RVFAC、三尖瓣瓣环平面收缩期运动速度和三尖瓣侧壁瓣环收缩期速度）与 MATEs 相关。
儿科 HT 患者在 HT 后第一年内心脏左、右心室功能逐渐改善。与 MATEs 相关的双心室功能参数。本研究结果为设计该人群更大、更长时间的随访铺平了道路，可能旨在使用多参数超声心动图预测不良事件。
