title: Impact of medical therapy on pulmonary hypertension in patients with congestive heart failure awaiting cardiac transplantation.
abstract: Pulmonary artery (PA) hypertension in transplant recipients increases mortality from right heart failure following heart transplantation. We examined the impact of long-term medical therapy on the severity of PA hypertension in patients with end-stage congestive heart failure on a transplant waiting list. The initial and final, quarterly right heart catheterization data on 60 patients (50 men, aged 50 +/- 9 years, New York Heart Association class III to IV) awaiting heart transplantation were analyzed and the patients divided into 2 groups: group A, those with persistent elevated systolic PA pressures throughout the 10-month follow-up (n = 31 of 60), and group B, those who had any decrease in systolic PA pressure during that period (n = 29 of 60). Group A had no change in hemodynamics. Group B had a significant decrease( +/- SD) in right atrial (11 +/- 7 to 5 +/- 4 mm Hg), PA (57 +/- 11 to 37 +/- 11 mm Hg), and PA wedge (25 +/- 9 to 14 +/- 7 mm Hg) pressures, with increases in cardiac output (3.8 +/- 0.9 to 4.7 +/- 1.1 L/min) and ejection fraction (18 +/- 6% to 27 +/- 11%) (p < 0.05). The combined end point of transplant or death occurred in 28 of 31 patients (90%) in group A versus 14 of 29 (50%) in group B (p = 0.0004). Ischemic etiology was present in 71 % of patients in group A versus 68% with idiopathic dilated cardiomyopathy in group B (p = 0.003). The reversibility of PA hypertension rather than its initial severity is predictive of patient clinical outcome. Idiopathic, as opposed to ischemic, cardiomyopathy responds better to medical therapy.
authors: Henry Ford Heart and Vascular Institute, Detroit, Michigan, USA.
authors: T B
authors: TB
authors: Levine
authors: A B
authors: AB
authors: Levine
authors: D
authors: D
authors: Goldberg
authors: B
authors: B
authors: Narins
authors: S
authors: S
authors: Goldstein
authors: M
authors: M
authors: Lesch
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016280:Atrial Function, Right; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002311:Cardiomyopathy, Dilated / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications; D014850:Waiting Lists
chemical_list: D000959:Antihypertensive Agents