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Transplantation. 2019 Apr 4. doi: 10.1097/TP.0000000000002738. [Epub ahead of print]

Reduced biventricular volumes and myocardial dysfunction long-term after pediatric heart transplantation assessed by CMR.

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Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre, Munich, Germany.
Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
MUON-STAT Statistical Consulting, Stuttgart, Germany.
Department of Heart-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Germany.
German Competence Network for Congenital Heart Defects, Berlin, Germany.
Department of Pediatric Cardiology, University Children's Hospital Ulm, Germany.



Long-term cardiac remodeling after heart transplantation (HT) in children has been insufficiently characterized. The aim of our study was to evaluate ventricular size in HT patients using cardiovascular magnetic resonance (CMR) imaging, to find underlying factors related to potentially abnormal cardiac dimensions and to study its impact on functional class and ventricular function.


Seventy-five pediatric HT recipients (age 14.0 ± 4.2 years) were assessed by CMR 11.2 ± 5.4 years after HT. Right (RV) and left ventricular (LV) volumes and mass were derived from short-axis cine images and myocardial strain/strain rate was assessed using myocardial feature tracking technique. Results were compared with a healthy reference population (n=79, age 13.7 ± 3.7 years).


LV end-diastolic ventricular volumes were smaller (64 ± 12 vs. 84 ± 12 ml/m, p<0.001) while mass-to-volume ratio (0.86 ± 0.18 vs. 0.65 ± 0.11, p<0.001) and heart rate (92 ± 14 vs. 78 ± 13 bpm, p<0.001) were higher in HT patients. LV-EF was preserved (66 ± 8 vs. 64 ± 6 %, p=0.18) but RV-EF (58 ± 7 vs. 62 ± 4 %, p=0.004), LV systolic longitudinal strain (-12 ± 6 vs. -15 ± 5 %, p=0.05), diastolic strain rate (1.2 ± 0.6 vs. 1.5 ± 0.6 1/s, p=0.03) and intra- and interventricular synchrony were lower in the HT group. Smaller LV dimensions were primarily related to longer follow-up time since HT (β=-0.38, p<0.001) and were associated with worse functional class and impaired ventricular systolic and diastolic performance.


Cardiac remodeling after pediatric HT is characterized by reduced biventricular size and increased mass-to-volume ratio. These adverse changes evolve gradually and are associated with impaired functional class and ventricular dysfunction suggesting chronic maladaptive processes affecting allograft health.

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