Long-term myocardial function after heart transplantation.
With an increasing number of heart transplantations and an improved survival rate a characterization of the long-term hemodynamic profile of the transplanted heart is necessary. 222 cardiac catheterizations were performed in 71 heart recipients under cyclosporine A immunosuppression during a 7-year follow-up after transplantation. Hemodynamic evaluation revealed a non-progressive arterial hypertension due to an increased systemic vascular resistance, leading to a mild increase of left-ventricular chamber stiffness. Parameters of systolic myocardial function were found to be normal and did not deteriorate during the 7 year period. The prevalence of allograft coronary angiopathy increased from 13% one year to 54% five years after transplantation. Myocardial function was neither adversely influenced by the presence of coronary angiopathy nor by the number or severity of former rejection episodes. Unchanged annual pressure-volume loops excluded the development of a dilated or restrictive posttransplantation cardiomyopathy. Thus, not the myocardial function, but the coronary angiopathy represents the most critical cardiac long-term problem after transplantation.
von Scheidt
W
W
Department of Internal Medicine I, Klinikum Grosshadern, Munich University, Germany.
Ziegler
U
U
Kemkes
B M
BM
Reichart
B
B
Erdmann
E
E
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D006328:Cardiac Catheterization; D002648:Child; D004699:Endocardium / Q000473:pathology; D005500:Follow-Up Studies; D005860:Germany, West / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D006321:Heart / Q000503:physiopathology*; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology* / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D013997:Time Factors