Deipanjan Nandi1, Clifford Chin2, Kurt R Schumacher3, Matthew Fenton4, Rakesh K Singh5, Kimberly Y Lin6, Jennifer Conway7, Ryan S Cantor8, Devin A Koehl8, Jacqueline M Lamour9, James K Kirklin8, Elfriede Pahl10. 1. Department of Pediatrics, Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: Deipanjan.Nandi@nationwidechildrens.org. 2. Department of Pediatrics, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 3. Department of Pediatrics, Division of Cardiology, C S Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan. 4. Department of Pediatrics, Division of Cardiology, Great Ormond Street Hospital for Children, London, United Kingdom. 5. Department of Pediatrics, Division of Cardiology, Hassenfeld Children's Hospital at NYU Langone, New York, New York. 6. Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada. 8. Department of Cardiothoracic Surgery, Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama. 9. Department of Pediatrics, Division of Cardiology, Children's Hospital at Montefiore, Bronx, New York. 10. Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Abstract
BACKGROUND: Coronary allograft vasculopathy (CAV) is a leading cause of mortality after heart transplantation (HT) in children. Variation in CAV screening practices may impact detection rates and patient outcomes. METHODS: Among 50 Pediatric Heart Transplant Society (PHTS) sites from 2001 to 2016, coronary evaluations were classified as angiography or non-invasive testing, and angiograms were designated as routine or symptom based. CAV detection rates stratified by routine vs symptom-based angiograms were calculated. Freedom from CAV and mortality after CAV diagnosis, stratified by study indication, were calculated. RESULTS: A total of 3,442 children had 13,768 coronary evaluations; of these, 97% (n = 13,012) were for routine surveillance, and only 3% (n = 333) were for cause. Over the study period, CAV was detected in 472 patients (14%). Whereas 58% (n = 29) of PHTS sites evaluate by angiography alone, 42% reported supplementing with a non-invasive test, although only 423 non-invasive studies were reported. Angiographic detection of CAV was higher for symptom-based testing than for routine testing (29% vs 4%, p < 0.0001), although routine testing identified a majority of cases (88%; n = 414). The 10-year freedom from CAV was 77% overall. Once CAV is detected, 5-year graft survival was 58%, with lower survival for patients diagnosed after symptoms angiogram than after routine angiogram (30% vs 62%; p < 0.0001). CONCLUSIONS: Development of a robust model for CAV risk should allow low-risk patients to undergo less frequent invasive angiography without adverse impact on CAV detection rates or outcomes.
BACKGROUND: Coronary allograft vasculopathy (CAV) is a leading cause of mortality after heart transplantation (HT) in children. Variation in CAV screening practices may impact detection rates and patient outcomes. METHODS: Among 50 Pediatric Heart Transplant Society (PHTS) sites from 2001 to 2016, coronary evaluations were classified as angiography or non-invasive testing, and angiograms were designated as routine or symptom based. CAV detection rates stratified by routine vs symptom-based angiograms were calculated. Freedom from CAV and mortality after CAV diagnosis, stratified by study indication, were calculated. RESULTS: A total of 3,442 children had 13,768 coronary evaluations; of these, 97% (n = 13,012) were for routine surveillance, and only 3% (n = 333) were for cause. Over the study period, CAV was detected in 472 patients (14%). Whereas 58% (n = 29) of PHTS sites evaluate by angiography alone, 42% reported supplementing with a non-invasive test, although only 423 non-invasive studies were reported. Angiographic detection of CAV was higher for symptom-based testing than for routine testing (29% vs 4%, p < 0.0001), although routine testing identified a majority of cases (88%; n = 414). The 10-year freedom from CAV was 77% overall. Once CAV is detected, 5-year graft survival was 58%, with lower survival for patients diagnosed after symptoms angiogram than after routine angiogram (30% vs 62%; p < 0.0001). CONCLUSIONS: Development of a robust model for CAV risk should allow low-risk patients to undergo less frequent invasive angiography without adverse impact on CAV detection rates or outcomes.
Authors: Anastasia Schleiger; Peter Kramer; Stephan Dreysse; Stephan Schubert; Björn Peters; Joachim Photiadis; Felix Berger; Johannes Nordmeyer Journal: Pediatr Cardiol Date: 2021-12-13 Impact factor: 1.655