Doppler tissue imaging in children following cardiac transplantation: a comparison to catheter derived hemodynamics

Previous studies have demonstrated a correlation between E:E(a) and ventricular filling pressure in adults after heart transplantation. We sought to determine if E:E(a) correlates with filling pressure after heart transplantation in children. A prospective analysis of children who have undergone heart transplantation was performed. Inflow and myocardial velocities were recorded and compared to catheter-derived filling pressures and rejection status. We performed 61 studies in 49 subjects. No correlation was found between septal E:E(a) and PCWP (r=0.14, p=0.28); or between lateral tricuspid E:E(a) and mean RAp (r=0.04, p=0.79). However, the mean PCWP was higher among subjects with elevated septal E:E(a) (>12) compared to normal E:E(a) (12.3±2.8mmHg vs. 10.1±2.9mmHg, p=0.02). Similarly, mean RAp was higher among subjects with an elevated lateral tricuspid E:E(a) (>10) compared to normal lateral tricuspid E:E(a) (7.7±2.1mmHg vs. 6.0±2.4mmHg, p=0.04). Elevated septal E:E(a) was also associated with high-grade cellular rejection (OR=17.3 95% CI 1.4-221], p=0.028). In children following heart transplant, E:E(a) does not correlate well with the range of filling pressures seen after pediatric heart transplantation. However, a septal E:E(a)>12 is associated with elevated PCWP and high grade cellular rejection and a lateral tricuspid E:E(a)>10 is associated with elevated mean RAp.