Right Ventricular Dysfunction by Echocardiography Is an Early Marker of Evolving Cardiac Allograft Vasculopathy in Children After Heart Transplantation
Bibliographic record
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is the leading cause of late graft loss in children after pediatric heart transplantation (HTx). Coronary angiography, the reference standard for diagnosis, is invasive and carries a risk of complications. Noninvasive echocardiographic methods to reliably identify CAV in children have not yet been defined. METHODS: This study assessed the utility of functional echocardiography (FE) in the diagnosis of CAV in children. We prospectively assessed all children (< 18 years old) post-HTx during routine clinical surveillance between 2005 and 2020. For this study, we compared patients diagnosed with CAV (angiographic ISHLT criteria) with transplanted children without CAV, with FE at the time of diagnosis (d-CAV) and 6-12 months before diagnosis (pre-CAV), and evaluated clinical risk factors. RESULTS: We identified 10 children with CAV and 11 matched controls (CON). Right ventricular longitudinal strain (RV LS) and strain rate (RV LSR) were reduced at d-CAV (d-CAV RV LS, 12.1% [9.2,16.1] vs. CON RV LS, 21.5% [18.2,25.7]; d-CAV RV LSR, 0.75%/s [0.48, 0.98] vs. CON RV LSR, 1.35%/s [0.95,1.50], p < 0.01 for all) and pre-CAV (pre-CAV RV LS, 17.3% [10.8,20.2] vs. CON RV LS, 21.5% [18.2,25.7]; pre-CAV RV LSR 0.95%/s [0.80,1.10] vs. CON RV LSR, 1.35%/s [0.95,1.50], p ≤ 0.05 for all). Patients with CAV were more likely to have class II donor-specific antibodies (p = 0.01). CONCLUSION: Right ventricle systolic strain parameters were reduced as early as 12 months prior to CAV diagnosis, while the left ventricle functional parameters remained preserved. FE of the right ventricle may be a useful noninvasive tool for early recognition of developing CAV in transplanted children.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".