Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation.
A profile of hemodynamic abnormalities in patients listed for cardiac transplantation was related to survival during the first year after listing. After a patient is listed for cardiac transplantation, the waiting period for a suitable donor heart is often long; therefore, objective criteria to determine risk would be helpful in identifying the group at highest risk of dying before receiving a transplant. Several studies have suggested certain hemodynamic parameters to be related to a poor prognosis. However, no 1 variable has emerged as an adequate predictor of survival in patients awaiting cardiac transplantation. One-year outcomes were examined in 138 consecutive patients listed for cardiac transplantation, who were grouped according to a hemodynamic risk score (HRS) based on abnormalities in baseline measures of right atrial pressure, pulmonary artery systolic pressure, transpulmonary gradient, cardiac output, cardiac index and pulmonary vascular resistance. Right atrial pressure alone was the most significant predictor of survival (p < 0.05). Patients with a right atrial pressure > 12 mm Hg had a 47% 1-year survival as compared with the 68% survival for those with a right atrial pressure < 12 mm Hg. HRS was the next strongest predictor of survival. The 66% survival in group I (HRS = 0) and the 69% survival in group II (HRS = 1 to 3) were significantly (p < 0.03) higher than the 41% survival in group III (HRS = 4 to 6) at 1 year after listing. Differences in survival for the HRS groups could not be explained by left ventricular ejection fraction, left ventricular end-diastolic diameter or status at listing.(ABSTRACT TRUNCATED AT 250 WORDS)
Morley
D
D
Heart Failure and Transplant Center, Hahnemann University, Philadelphia, Pennsylvania 19102-1192.
Brozena
S C
SC
D016275:Atrial Function / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000503:physiopathology; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D015143:Philadelphia / Q000453:epidemiology; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012307:Risk Factors; D015996:Survival Rate; D014655:Vascular Resistance / Q000502:physiology; D014850:Waiting Lists
D002316:Cardiotonic Agents