Response of right ventricular function to prostaglandin E1 infusion predicts outcome for severe chronic heart failure patients awaiting urgent transplantation.
BACKGROUND
Selection of patients for urgent heart transplantation who have end-stage heart failure requires objective criteria to distinguish between subjects who may deteriorate clinically and those who can be stabilized. This population appears to differ in terms of right ventricular function, and right ventricular changes in loading may provide prognostic information. To investigate predictive parameters of patients admitted for urgent heart transplantation, we prospectively studied the mechanical performance of the right ventricle during acute afterload reduction.


METHODS
We studied 68 heart failure patients hospitalized for bridge-to-transplant. The patients underwent right heart catherization at baseline and during prostaglandin E1 infusion. We stratified patients according to clinical outcome: Group A comprised patients who could be weaned from bridging therapy or who were electively transplanted after at least 90 days, and Group B comprised patients who died or who remained unstable and required transplant under urgent conditions.


RESULTS
Right ventricular hemodynamics at baseline were comparable in both groups. However, during maximal vasodilatation, with prostaglandin E1 infusion, the right ventricular end-diastolic volume index (EDVI) was significantly reduced in Group A, (-23 ml/m(2) (p < 0.01) vs +12 ml/m(2) (p = n.s. DeltaEDVI in Group B. Reduction of EDVI by less than 10% during prostaglandin E1 infusion has a sensitivity of 89% and a specificity of 70% for clinical deterioration.


CONCLUSIONS
The response of right ventricular volumes to prostaglandin E1 may predict the outcome of patients with severe congestive heart failure listed for urgent heart transplantation.
Hülsmann
M
M
Department of Internal Medicine II, Division of Cardiology, University of Vienna, Vienna, Austria.
Stefenelli
T
T
Berger
R
R
Sturm
B
B
Parkner
A
A
Zuckermann
A
A
Woloszczuk
W
W
Pacher
R
R
D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*; D016278:Ventricular Function, Right
D014665:Vasodilator Agents; D000527:Alprostadil