Association of Pediatric Heart Transplant Coronary Vasculopathy with Abnormal Hemodynamic Measures

Abstract

Objective. Transplant coronary artery disease (TCAD) is the limiting factor to long‐term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter‐derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients.Design, Patients, Outcome Measures. Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheter‐derived right ventricular end‐diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.Results. TCAD was diagnosed an average of 8.3 years post‐HTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheter‐derived pressure measurements showed that RVEDP was elevated in TCAD compared with non‐TCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10 mm Hg or PCWP > 12 mm Hg was associated with TCAD (OR = 5.2; P= .010).Conclusions. In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.