Echocardiographic Estimation of Left Ventricular Filling Pressures in Heart Transplant Recipients

Purpose: LV diastolic dysfunction has often been described as a sensitive sign of early graft rejection. Assessment of left ventricular filling pressure by echocardiography in heart transplant (HTx) recipients is challenging. We aimed to investigate the ability of echocardiographic indices to detect elevated Left ventricular end-diastolic pressure (LVEDP) in HTx patients. Methods This descriptive cross-sectional study included 39 HTx recipients who were candidates for endomyocardial biopsy as a part of their routine post-transplantation surveillance. Doppler transthoracic echocardiography was done before the procedure, and left heart catheterization was done during the endomyocardial biopsy. Results Thirty-nine patients (15 female, 24 male), with the mean age of 39.6 years (range 13 to 70), were enrolled. A strong relation was observed between lateral E/e’ and LVEDP (R = 0.64, P-value < 0.001) and average E/e’ and LVEDP (R = 0.6, P-value < 0.001). The best cutoff value for LVEDP prediction was the average E/e’ ≥ 6.8 with a sensitivity of 96.15% and specificity of 68.5% for the prediction of LVEDP more than or equal to 20mmHg. Two predictive models comprising age, gender, and lateral E/e’ or average E/e’ were also proposed. A significant relationship was also found between LVEDP and left ventricular global longitudinal strain (R=-0.31, P-value < 0.01). Conclusion Lateral E/e’ was the best predictor of LVEDP. The cutoff of average E/e’ had the best validity for the estimation of LVEDP. Despite the strong observed association, echocardiographic parameters still cannot consider as a surrogate for invasive LVEDP measurements when seeking information about left ventricle filling pressure on heart transplant recipients.