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Elevated Aortic Stiffness after Pediatric Heart Transplantation

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Abstract

In adults, arterial stiffness has been linked to the development of target end-organ damage, thought to be related to abnormal transmission of pulse pressure. Increased arterial stiffness and endothelial dysfunction have been hypothesized to contribute to the development of microvascular dysfunction and coronary allograft vasculopathy (CAV), an important comorbidity after heart transplantation. However, little data exists regarding arterial stiffness in pediatric heart transplantation and its influence on development of coronary allograft vasculopathy is not well understood. We sought to assess aortic stiffness and distensibility in pediatric post-heart transplant patients. A prospective, observational study analyzing the ascending (donor tissue) and descending aorta (recipient tissue) using transthoracic echocardiographic M-mode measurements in patients aged < 21 years was conducted. Descending and ascending aorta M-modes were obtained from the subcostal long axis view, and the parasternal long axis view 3–5mm above the sinotubular junction, respectively. Two independent reviewers averaged measurements over 2–3 cardiac cycles, and Aortic Distensibility (AD) and Aortic Stiffness Index (ASI) were calculated using previously validated methods. We recruited 39 heart transplant (HT) patients and 47 healthy controls. Median end diastolic dimension of the ascending aorta (donor tissue) was significantly larger in the transplant group than the control group (1.92 cm vs. 1.74 cm, p = 0.01). Ascending aortic distensibility in post-transplant patients was significantly lower than in the control group (4.87 vs. 10.53, p < 0.001). Ascending aortic stiffness index was higher in the transplant patients compared to the controls (4.63 vs. 2.21, p < 0.001). There is evidence of altered ascending aortic distensibility and stiffness parameters in post-heart transplant patients. Further studies are required to assess its influence on complications like development of coronary artery vasculopathy.

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Fig. 1

Reproduced with permission from Chirinos JA, et. al: Large-Artery Stiffness in Health and Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019;74:1237-63

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Acknowledgements

We would like to thank the following UF Health sonographers for their contribution to the study: Amanda Whitlow, Jennifer Bass, Sekoyia Briseno, Christina Gauthier, Kristie Sanders, Katie Clymer, Deborah Good, and Megan Gonzalez

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  1. John-Anthony Coppola and Dipankar Gupta shares co-first authorship.

Authors and Affiliations

  1. Congenital Heart Center, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA

    John-Anthony Coppola, Dipankar Gupta, Dalia Lopez-Colon, Curt DeGroff & Himesh V. Vyas

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  1. John-Anthony Coppola
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  2. Dipankar Gupta
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  3. Dalia Lopez-Colon
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  4. Curt DeGroff
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Contributions

All authors contributed to the study conception, design, and manuscript preparation. Data collection and analysis were performed by [J-AC], [HV] and [DLC]. The first draft of the manuscript was written by [J-AC] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. This work was partially funded by NCATS grant UL1TR001427.

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Correspondence to Dipankar Gupta.

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Coppola, JA., Gupta, D., Lopez-Colon, D. et al. Elevated Aortic Stiffness after Pediatric Heart Transplantation. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03245-3

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