Journal ArticleDOI
Increased myocardial performance index correlates with biopsy-proven rejection in pediatric heart transplant recipients.
Glenn T. Leonard,F. Jay Fricker,Debra Pruett,Kelli Harker,Barbara J Williams,Kenneth O. Schowengerdt +5 more
TLDR
Increased LVMPI correlated with biopsy-proven rejection, and frequent serial assessments using this technique may provide a relatively sensitive non-invasive means of rejection surveillance after pediatric cardiac transplantation.Abstract:
Background To date, cardiac catheterization and endomyocardial biopsy have been considered the "gold standard" for rejection surveillance after heart transplantation. Factors such as patient size (i.e., infant transplantation), loss of vascular access after repeated catheterizations, and anesthesia requirements all present unique problems and risks related to pediatric rejection surveillance. Therefore, additional methods to monitor for rejection in a non-invasive, reliable and frequent manner have been sought. We studied the utility of echocardiographic measurement of the left ventricular myocardial performance index (LVMPI), a reproducible measure of combined systolic and diastolic performance, in pediatric heart transplant recipients as a method of identifying acute rejection. Methods Two-dimensional/Doppler echocardiographic studies ( n = 36) were performed on 21 cardiac transplant patients (ages 6.2 to 21.9 years) at the time of endomyocardial biopsy. The LVMPI, the sum of the isovolumic contraction time and isovolumic relaxation time divided by aortic ejection time, was determined at each study, as well as other echocardiographic measures of systolic and diastolic function. Patients were grouped by concurrent histologic rejection grade and the results compared between groups. Results Significant differences in LVMPI ( p n = 23) and those with moderate to severe rejection (Grade 3; n = 5), as well as between those with no rejection and those with focal moderate (Grade 2; n = 8) rejection ( p n = 7). No significant differences were noted between groups for left ventricular ejection fraction or shortening fraction, percent septal or posterior wall thickening, left ventricular mass index or mitral valve deceleration time. In addition, for those individual patients with multiple studies, the LVMPI consistently increased with higher rejection grades and decreased after therapy. Conclusions In this series, increased LVMPI correlated with biopsy-proven rejection, and frequent serial assessments using this technique may provide a relatively sensitive non-invasive means of rejection surveillance after pediatric cardiac transplantation. False positive results may be encountered, likely due to alterations in diastolic function that have been previously observed in transplant recipients.read more
Citations
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Journal ArticleDOI
Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants.
TL;DR: After PDA ligation, LV output and MPI decrease, due primarily to a decrease in LV preload, although LV contractility and diastolic function do not change, however, the changes in LV MPI after ligation also reflect an acute deterioration followed by an improvement in global cardiac function.
Journal ArticleDOI
Decline in rejection in the first year after pediatric cardiac transplantation: a multi-institutional study
Jeffrey G. Gossett,Charles E. Canter,Jie Zheng,Kenneth B. Schechtman,Elizabeth D. Blume,Sherrie Rodgers,David C. Naftel,James K. Kirklin,Janet Scheel,F.J. Fricker,Paul F. Kantor,Elfriede Pahl +11 more
TL;DR: The overall incidence and prevalence of rejection has substantially decreased over time in pediatric HTx recipients in the first year after HTx, but the rate of rejection with hemodynamic compromise or death from rejection remains unchanged.
Journal ArticleDOI
Non-invasive approaches for the diagnosis of acute cardiac allograft rejection
Christopher A. Miller,James E. Fildes,Simon Ray,H. Doran,Nizar Yonan,Simon G. Williams,Matthias Schmitt +6 more
TL;DR: The evidence for non-invasive methods of diagnosing acute rejection, including assessment of myocardial deformation, myocardIAL tissue characterisation, electrophysiological monitoring, visualisation of cellular and molecular components of rejection and peripheral monitoring of immune activation, is reviewed.
Journal ArticleDOI
Changes in Longitudinal Myocardial Deformation during Acute Cardiac Rejection: The Clinical Role of Two-Dimensional Speckle-Tracking Echocardiography
TL;DR: GLS is significantly reduced during moderate (2R) ACR and improves significantly in the resolving period and the present results provide encouraging evidence to consider the routine use of GLS as a marker of graft function involvement during ACR.
Journal ArticleDOI
Cardiac allograft function during the first year after transplantation in rejection-free children and young adults.
Fatima I Lunze,Steven D. Colan,Kimberlee Gauvreau,Ming-Hui Chen,Antonio R. Perez-Atayde,Elizabeth D. Blume,Tajinder P. Singh +6 more
TL;DR: Pediatric HT recipients have biventricular dysfunction using pulsed-wave tissue Doppler imaging early after HT with most significant impairment in RV systolic function and RV and LV early-diastolic filling.
References
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Journal Article
A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation.
Margaret E. Billingham,N. R. B. Cary,M. E. Hammond,J. Kemnitz,Charles C. Marboe,H. A. Mccallister,D. C. Snovar,Gayle L. Winters,A. Zerbe +8 more
Journal Article
New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy
Chuwa Tei,Lieng H. Ling,David O. Hodge,Kent R. Bailey,Jae K. Oh,R J Rodeheffer,Abdul J. Tajik,James B. Seward +7 more
TL;DR: (ICT+IRT)/ET is a conceptually new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance in patients with primarymyocardial systols dysfunction and was easily measured, reproducible, and had a narrow range in normals.
Journal ArticleDOI
Nongeometric Quantitative Assessment of Right and Left Ventricular Function: Myocardial Performance Index in Normal Children and Patients with Ebstein Anomaly
TL;DR: The myocardial performance index quantitatively reflects ventricular performance in patients with complex ventricular geometry (ie, Ebstein anomaly) and in the absence of a geometric solution, this nongeometric index is particularly appealing for the assessment of RV or LV performance.
Journal Article
Serial echocardiographic evaluation of cardiac graft rejection after infant heart transplantation
TL;DR: Serial echocardiographic studies were prospectively performed on 20 infants to quantitate the myocardial response to rejection and the utility of these echOCardiographic measurements to predict rejection has not been prospectively compared with the endomyocardial biopsy.
Journal Article
Echocardiographic abnormalities with acute cardiac allograft rejection in children: correlation with endomyocardial biopsy.
TL;DR: In this article, echocardiograms of the left ventricle were digitized and analyzed with a computer-assisted measurement format for left ventricular size, mass, and wall motion in systole and diastole.
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