Multimodality Surveillance for Cardiac Allograft Vasculopathy After Pediatric Heart Transplantation

All articles of this category (opens in new window) Background: In pediatric heart transplant recipients, cardiac allograft vasculopathy (CAV) and elevated left ventricular filling pressures are associated with poorer graft survival. The current gold standard for surveillance remains cardiac catheterization with coronary angiography. To reduce procedural risk and burden, we aimed to evaluate a noninvasive multimodality diagnostic approach for CAV surveillance after pediatric heart transplantation (HT). Methods: We retrospectively screened patients who underwent (re-) HT at 12 mmHg, respectively. We divided our cohort into two groups: (1) CAV1–3 or elevated filling pressures and (2) no CAV (grade 0) and normal filling pressures. Differences between groups were calculated using Hedges’ g as the effect size measure due to the small cohort and different group sizes, and reported with 95% confidence intervals (CI). Results: We included 54 patients ( n = 48 with angiography) with median age at HT of 6.2 years (IQR: 1.8–12.8) and 13.2 years (9.4–16.8) at catheterization, respectively. In 94% of patients, CAV0 was observed. Overall median LVEDP was 9 mm Hg (7–11), while eight patients had elevated filling pressures. Median LVEF was 57% (52–63) and absolute LV global longitudinal strain 16.3% (14.2–18.6). Late gadolinium enhancement was positive in 2 of 27 patients. Group comparisons [(1) n = 10, (2) n = 35] showed a significant difference in median time post-HT of 9.9 (6.4–13) vs. 4.9 (2.8–8.5) years. The largest effect sizes were observed for echocardiographic mitral valve E-Wave velocity at 107 cm/s vs. 90 cm/s (0.86, CI: 0.07–1.64), septal E/E’ at 12.4 vs. 9.3 (0.79, CI: 0.001–1.58), and NT-proBNP at 1,590 vs. 343 pg/mL (1.15, CI: 0.18–2.1). Conclusion: In our pediatric HT cohort, noninvasive echocardiographic mitral valve E-wave velocity, septal E/E’, as well as NT-proBNP, were higher in patients with invasively confirmed CAV or elevated filling pressures. This provides reference data for further prospective studies with larger cohorts to explore this noninvasive multimodality approach. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany