Elevated right atrial pressure by echocardiography significantly increases the likelihood of concomitant elevated pulmonary capillary wedge pressure in heart transplant recipients

1.A family of structurally related but genetically distinct natriuretic peptides exist which include atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) of myocardial cell origin and C-type natriuretic peptide (CNP) of endothelial and renal epithelial cell origin. All three exert actions via cGMP, with ANP and BNP functioning via the natriuretic peptide A receptor and CNP via the natriuretic peptide B receptor. 2.Circulating and urinary natriuretic peptides were determined in response to acute intravascular volume overload (AVO). Additionally, their functional role in cardiorenal regulation during AVO was investigated by utilizing the natriuretic peptide receptor antagonist HS-142-1. Control (n = 5) and study dogs (HS-142-1, n = 9) underwent AVO with normal saline equal to 10% of body weight over 1 ;h. Both groups demonstrated similar significant increases in right atrial pressure, pulmonary capillary wedge pressure, pulmonary artery pressure and cardiac output. Circulating ANP paralleled increases in right atrial pressure and pulmonary capillary wedge pressure, with no changes in plasma BNP or CNP. At peak AVO, urinary CNP excretion was increased compared with baseline (7.0±4.2 versus 62±8.0 ;pg/min, P< 0.05). 3.In the HS-142-1-treated group, plasma cGMP was decreased compared with the control group (9.6±1.1 to 5.0±1.2 ;pmol/ml, P< 0.05). A significant attenuation of natriuresis (566±91 versus 1241±198 ;μEq/min, P< 0.05) and diuresis (4.8±0.7 versus 10.1±2.0 ;ml/min, P< 0.05) was also observed at peak AVO in the HS-142-1 treated group. 4.These findings support differential and selective responses of the three natriuretic peptides to AVO, in which plasma ANP and urinary CNP are markers for AVO. Secondly, these studies confirm the role of ANP and CNP but not BNP in the natriuretic and diuretic response to acute volume overload.

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Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type natriuretic peptide

Cardiology in the Young ◽

10.1017/s104795112100247x ◽

2021 ◽

pp. 1-8

Author(s):

Bethany L. Wisotzkey ◽

Bereketeab Haileselassie ◽

Neal Jorgensen ◽

Erin L. Albers ◽

Mariksa S. Kemna ◽

...

Keyword(s):

Heart Rate ◽

Natriuretic Peptide ◽

Heart Transplant ◽

Left Ventricular ◽

Right Atrial ◽

Z Score ◽

Transplant Recipients ◽

Pulmonary Capillary ◽

Echocardiographic Parameters ◽

Heart Transplant Recipients

Abstract Background: Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters. Methods: A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data. Results: Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e’, and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e’ were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index. Conclusions: B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.

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Effect of a reduced donor heart right ventricular distensibility on post-heart transplant haemodynamics

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa222 ◽

2020 ◽

Vol 32 (1) ◽

pp. 141-149

Author(s):

Yuki Nakamura ◽

Daisuke Yoshioka ◽

Hidetsugu Asanoi ◽

Shigeru Miyagawa ◽

Yasushi Yoshikawa ◽

...

Keyword(s):

Right Ventricular ◽

Pulmonary Capillary Wedge Pressure ◽

Heart Transplant ◽

Right Atrial ◽

Interstitial Tissue ◽

Donor Heart ◽

Pulmonary Capillary ◽

The Mean ◽

Wedge Pressure ◽

Ventricular Distensibility

Abstract OBJECTIVES This study aimed to investigate the characteristics of a reduced right ventricular distensibility after heart transplant. METHODS This study enrolled 64 adult patients who underwent heart transplant at our institution. The degree of right ventricular distensibility was quantified by calculating the difference between right atrial pressures (RAPs) of X descent and Y descent (X–Y) from the RAP waveform in right heart catheterization. Histologically, the ratio of the interstitial tissue in myocardial biopsy samples was calculated. RESULTS Of the 64 patients, 35 (55%) had a reduced right ventricular distensibility at 1 week after heart transplant (X–Y > 1 mmHg, RD group), and 29 (45%) had a normal right ventricular distensibility (X–Y ≤ 1 mmHg, ND group). The mean RAP and mean pulmonary capillary wedge pressure 1 week after heart transplant in the RD group were significantly higher than that in the ND group. The mean RAP and mean pulmonary capillary wedge pressure in the RD group gradually normalized 12 weeks postoperation. The ratio of the interstitial tissue of biopsy samples significantly correlated with the X–Y value. The number of patients who required inotropic support >14 days was higher in the RD group than in the ND group. CONCLUSIONS Reduced donor heart distensibility was a common impairment early after heart transplant. It might result from interstitial oedema in the myocardial tissue of the donor heart. Reduced donor heart distensibility after heart transplant might be associated with early clinical outcomes; however, further investigation is required.

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