Altered Biatrial Phasic Function after Heart Transplantation in Children

Anitha Parthiban; Vivek Jani; Jin Zhang; Ling Li; Mary Craft; Aleissa Barnes; Jean A Ballweg; Andreas Schuster; David A Danford; Shelby Kutty

doi:10.1016/j.echo.2020.04.029

Altered Biatrial Phasic Function after Heart Transplantation in Children

J Am Soc Echocardiogr. 2020 Sep;33(9):1132-1140.e2. doi: 10.1016/j.echo.2020.04.029. Epub 2020 Jul 9.

Authors

Affiliations

¹ Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.
² The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
⁴ Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
⁵ The Blalock Taussig Thomas Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: skutty1@jhmi.edu.

PMID: 32653298
DOI: 10.1016/j.echo.2020.04.029

Abstract

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 (ε_r, SR_r), conduit (ε_cd, SR_cd), and booster (ε_ct, SR_ct) 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 (ε_r, SR_r), conduit (ε_cd, SR_cd), and booster (ε_ct, SR_ct) 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 ε_cd correlated weakly with donor age (r = -0.49, P = .04) and RA SR_r, and SR_cd 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.

Keywords: Atrial strain; Atrial strain rate; Heart transplantation; Pediatric cardiology; Two-dimensional speckle-tracking.

MeSH terms

Atrial Function, Left*
Child
Diastole
Echocardiography
Heart Atria / diagnostic imaging
Heart Transplantation*
Humans