title: Limitations of radionuclide angiographic assessment of left ventricular systolic function before lung transplantation.
abstract: To evaluate the influence of increased right ventricular afterload on radionuclide assessment of the left ventricular ejection fraction (LVEF), we compared the preoperative and postoperative value of isotopic LVEF in 11 patients who underwent lung transplantation and had a preoperative LVEF value below 55% (normal value: 68 +/- 8%). The underlying disease conditions were obstructive lung disease (n = 7) and pulmonary fibrosis (n = 4). The transplantation procedure was unilateral in 10 patients and bilateral in one. The mean value of isotopic LVEF prior to transplantation was 51 +/- 3% (range: 49% to 55%). At 42 +/- 13 mo postoperatively, isotopic LVEF increased significantly, to 65 +/- 10% (p = 0.001), suggesting that intrinsic left ventricular systolic function was in fact normal in these patients. We hypothesize that the low preoperative isotopic LEVF was not related to intrinsic dysfunction of the left ventricle, but rather to right ventricular pressure overload, leading to bulging of the interventricular septum into the left ventricle and to subsequent geometric distortion of the left ventricle. We conclude that isotopic LVEF may underestimate intrinsic left-ventricular systolic function in patients with severe chronic lung disease. Candidates for lung transplantation should not be rejected on the basis of a low isotopic LVEF, provided echocardiographic examination does show apparently normal left ventricular contraction.
authors.affiliation: Services de Pneumologie et Réanimation Respiratoire, Cardiologie, Chirurgie Thoracique et Vasculaire, and Médecine Nucléaire, Hôpital Beaujon, Clichy, France.
authors.forename: H
authors.initials: H
authors.lastname: Mal
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.forename: T
authors.initials: T
authors.lastname: Laperche
authors.forename: C
authors.initials: C
authors.lastname: Sleiman
authors.forename: J L
authors.initials: JL
authors.lastname: Stievenart
authors.forename: A
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: O
authors.initials: O
authors.lastname: Brugière
authors.forename: G
authors.initials: G
authors.lastname: Lesèche
authors.forename: G
authors.initials: G
authors.lastname: Jebrak
authors.forename: M
authors.initials: M
authors.lastname: Fournier
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011658:Pulmonary Fibrosis / Q000503:physiopathology / Q000601:surgery; D011875:Radionuclide Angiography; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right