Association of Pediatric Heart Transplant Coronary Vasculopathy with Abnormal Hemodynamic Measures

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 \u3e 10mmHg or PCWP \u3e 12mmHg 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. © 2011 the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.