Symptom complex is associated with transplant coronary artery disease and sudden death/resuscitated sudden death in pediatric heart transplant recipients.

BACKGROUND

Transplant coronary artery disease (TCAD) is a common sequela of heart transplantation. Symptom complexes associated with TCAD have not been well described. The purpose of this study was to determine if somatic complaints are associated with TCAD in pediatric heart transplant recipients.

METHODS

We reviewed the medical records of all patients who underwent heart transplantation at our institution from November 1984 to December 2000. TCAD was defined as any interval narrowing of coronary arteries by angiography since the previous study or at least 50% luminal obstruction of 1 or more coronary arteries by histologic examination of explanted or autopsied hearts.

RESULTS

Ninety-nine patients received heart transplants, and follow-up data were available in 80. Sixty-six patients met study criteria. Complaints of abdominal (82%), chest (45%), abdominal and chest (27%), and arm (9%) pain were made by 22 (33%) of 66 patients, and TCAD was present in 27 (41%). Of the 22 patients with pain, TCAD was present in 18, for a positive predictive value of 82% (95% confidence interval [CI] 60%-95%). The relative risk of TCAD being present in patients with a history of pain was 4 times that of patients without pain (p < 0.001). Sudden death or resuscitated sudden death occurred in 15 (68%) of 22 patients with pain vs 4 (9%) of 44 without pain (p < 0.001).

CONCLUSIONS

The symptom complex of abdominal, chest and/or arm pain is strongly associated with the presence of TCAD and sudden death or resuscitated sudden death in pediatric heart transplant recipients.