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Decreased Global Myocardial Work Efficiency Correlates with Coronary Vasculopathy in Pediatric Heart Transplant Patients

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Abstract

Coronary angiography remains the standard for diagnosis of cardiac transplant vasculopathy (CAV), but it is invasive. Non-invasively derived left ventricle (LV) global myocardial work (GMW) indices have not been evaluated. We aimed to assess for correlations between LV GMW and the presence of CAV in a pediatric population. 24 heart transplant patients and 24 normal controls were prospectively enrolled. Patients were age-matched into groups with: orthotopic heart transplant and CAV (OHT-CAV; 6 patients, 33% male, mean age 13.5 years [SD 4.2]), orthotopic heart transplant without CAV (OHT; 18 patients, 67% male, mean age 11.1 years [SD 4.8]), and normal healthy controls (42% male, mean age 12.8 years [SD 5.0]). Transplant patients underwent cardiac catheterization with coronary angiography within 3 months of echocardiogram. Post-processing of echocardiograms with speckle-tracking echocardiography and derivation of GMW indices was performed. OHT-CAV patients had decreased global work efficiency (GWE) compared to OHT (mean difference = 7.01 [1.76, 12.25], adjusted p < 0.01). LV global longitudinal strain (GLS) and LV ejection fraction were not different between groups. Both global work index and GWE were decreased in OHT-CAV and OHT when compared to normal controls (OHT-CAV 1311.23 mmHg% vs OHT 1426.22 mmHg% vs controls 1802.81 mmHg%, adjusted p < 0.01; OHT-CAV 83.87% vs. OHT 90.87% vs. controls 95.41%, adjusted p < 0.01). GWE correlated negatively with the presence of CAV (r = − 0.44 [− 0.72, − 0.05]). This pilot study demonstrates decreased GWE correlates with pediatric CAV. This supports the need for further investigation of this promising diagnostic tool.

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Authors and Affiliations

  1. The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Sarah Pradhan, Anna Mullikin, Shelly Stark, Garick D. Hill, Clifford Chin & Justin T. Tretter

  2. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Huaiyu Zang & Nicholas J. Ollberding

  3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Nicholas J. Ollberding, Garick D. Hill, Clifford Chin & Justin T. Tretter

Authors
  1. Sarah Pradhan
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  2. Anna Mullikin
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  3. Huaiyu Zang
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  4. Nicholas J. Ollberding
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  5. Shelly Stark
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  6. Garick D. Hill
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  7. Clifford Chin
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  8. Justin T. Tretter
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Correspondence to Justin T. Tretter.

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No conflicts of interest to disclose, no research involving human participants or animals. Informed verbal consent was obtained from the patient or guardian prior to performing the echocardiogram.

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Pradhan, S., Mullikin, A., Zang, H. et al. Decreased Global Myocardial Work Efficiency Correlates with Coronary Vasculopathy in Pediatric Heart Transplant Patients. Pediatr Cardiol 43, 515–524 (2022). https://doi.org/10.1007/s00246-021-02748-1

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  • DOI: https://doi.org/10.1007/s00246-021-02748-1

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