Hemodynamic abnormalities following cardiac transplantation: relationship to hypertension and survival.
The prevalence and long-term implications of hemodynamic abnormalities seen at 1 year following orthotopic heart transplantation and their relationship to post-transplant hypertension were prospectively evaluated in 82 consecutive asymptomatic recipients taking cyclosporine and prednisone who underwent annual catheterization. Abnormal left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and left ventricular end-diastolic pressure-volume ratio (R) were the most prevalent hemodynamic abnormalities (27%, 14%, and 23%, respectively, at 1 year). Patients with abnormal LVEDP or R had higher (p less than 0.05) mean systemic arterial pressure (MAP). During follow-up, hemodynamic abnormalities disappeared in some patients while they developed in some others. Transplant patients with abnormal LVEDP, EF, or R at 1 year who normalized at 2 years had a significant (p less than 0.05) decrease in MAP. Likewise, patients with normal LVEDP, EF, or R at 1 year who subsequently developed abnormalities had a significant (p less than 0.05) increase in MAP. The presence of hemodynamic abnormalities at 1 year was not associated with a poorer survival (mean follow-up 2.6 +/- 1.1 years). In summary, hemodynamic abnormalities in asymptomatic transplant recipients taking cyclosporine and prednisone appear to be related to the level of post-transplant hypertension and do not signify an adverse prognosis over the first 3 years.
Murali
S
S
Department of Medicine, University of Pittsburgh School of Medicine, PA.
Uretsky
B F
BF
Reddy
P S
PS
Griffith
B P
BP
Hardesty
R L
RL
Trento
A
A
D000328:Adult; D001706:Biopsy; D001794:Blood Pressure / Q000187:drug effects; D017023:Coronary Angiography; D003524:Cyclosporins / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000503:physiopathology*; D008297:Male; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies
D003524:Cyclosporins; D011241:Prednisone