Echocardiography in Children
Altered Biatrial Phasic Function after Heart Transplantation in Children

https://doi.org/10.1016/j.echo.2020.04.029Get rights and content

Highlights

  • Pediatric HT recipients had altered mechanics of left and right atria.

  • Biatrial reservoir, conduit, and booster function are disrupted after transplantation.

  • Changes in atrial deformation were accompanied by significant atrial dilation.

  • Alterations in ventricular diastolic function or atrial geometry may be contributory.

Purpose

We used two-dimensional echocardiographic speckle-tracking to investigate whether left and right atrial (LA and RA) phasic function in pediatric heart transplantation (HT) patients is altered and explored the relationship to HT-related clinical variables.

Methods

Eighty-six subjects (36 HT and 50 normal children) were prospectively enrolled in two centers. Clinical data included age at HT, bypass time, ischemia time, donor age, and incidence of rejection. Atrial deformation indices including strain and strain rates (SRs) were measured using two-dimensional echocardiographic speckle-tracking. Components of phasic atrial function—reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) were calculated. Comparisons with controls were made using t test or Kruskal-Wallis test, and correlations to clinical variables were explored.

Results

The mean age and body surface area of HT subjects were 10.2 ± 6.2 years and 1.2 ± 0.6 m2, respectively. The mean heart rates were higher in HT (96 ± 18 vs 88 ± 21 in controls). There were reductions in RA and LA reservoir (εr, SRr), conduit (εcd, SRcd), and booster (εct, SRct) function in HT compared with controls. There was no relationship of LA and RA deformation indices with mean age at HT, bypass time, or ischemia time. The LA εcd correlated weakly with donor age (r = –0.49, P = .04) and RA SRr, and SRcd showed association with duration of HT (P < .05). Nineteen HT recipients had follow-up studies 0.24 ± 0.18 years after the first examination, and deformational indices were not significantly changed.

Conclusions

Atrial strain determination is feasible in pediatric HT recipients and demonstrates disruption of reservoir, conduit, and booster function of both atria in this population; we speculate this may be a consequence of ventricular diastolic dysfunction.

Section snippets

Study Population

We prospectively enrolled pediatric subjects, status post–orthotopic HT and normal controls from September 2013 to October 2015 in two centers. Subjects were recruited consecutively during the study time period at routine outpatient clinic visits or at the time of surveillance biopsy. Any subjects with biopsy or clinically proven rejection at the time of recruitment or baseline LV ejection fraction <55% (based on review of clinical reports) were excluded. Demographic data including age, height,

Results

The 86 subjects consisted of 50 normal controls (mean age 8.9 ± 5.6 years, 26/24 male/female) and 36 HT patients (mean age 10.2 ± 6.2 years, 16/20 male/female, and 55 examinations). No significant differences in age were observed between the controls and HT groups (P = .32). Additionally, within the HT group, no significant differences were observed between donor age and recipient age at transplant (P = .14). Follow-up examinations of the HT patients were excluded from the primary analysis, and

Discussion

We investigated the phasic function of the RA and LA using two-dimensional speckle-tracking echocardiography (2D-STE) in the transplanted pediatric heart relative to that of normal controls. Analysis was feasible in all but two of the 86 subjects with acceptable inter- and intraobserver variability.

Conclusion

Pediatric HT recipients had altered atrial mechanics up to 5 years after HT, indicating that the reservoir, conduit, and booster function of both atria may be measurably disrupted by implantation into the recipient. Atrial strain determination is feasible in pediatric HT and shows potential as a means for monitoring trends in ventricular diastolic function in this population. Larger, longitudinal studies are needed to determine whether these abnormalities in atrial function are predictive of

Acknowledgment

We thank Berthold Klas, MS, from TomTec Imaging Systems for technical support.

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    Conflicts of Interest: None.

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