title: Outcomes in patients with low left ventricular ejection fraction after heart transplantation.
abstract: OBJECTIVE
  Low left ventricular ejection fraction (EF) after heart transplantation (HT) is considered an ominous sign. We reviewed our database in order to determine outcomes in patients with low EF after HT and to identify a subset of patients who would benefit from immediate retransplantation.
  
  
  METHODS
  We identified 825 patients who underwent HT at our institution between December 1983 and July 1999. Of these, 81 patients (70 men, 11 women; age, 48+/-12 years) had low (<35%) EF as determined by radionuclide ventriculography. Post-transplantation survival; duration of low-EF episodes (>2 years vs. <2 years); and incidence of transplant rejection, infection, and transplant coronary artery disease (CAD) were determined for these patients.
  
  
  RESULTS
  On average, low EF developed 800+/-1029 days after HT and lasted 550+/-756 days until improvement, repeat HT, or death of the patient. Actuarial survival was 79% at 1 year, 55% at 3 years, and 46% at 5 years. Shorter (<2-year) episodes of low EF tended to have an earlier onset than prolonged (>2-year) episodes (656 days vs. 1341 days) (P=0.014). Patients with prolonged episodes (n=17) survived longer than patients with shorter episodes (n=64) (2247 days vs. 1266 days) (P=0.002). The incidence of hemodynamically significant rejection was lower in the prolonged low-EF group (6% [1/17] vs. 26% [17/64]) (P=0.03). The incidence of infection (31% vs. 53%) and incidence of transplant CAD (47% vs. 39%) did not differ significantly between the prolonged and shorter low-EF groups.
  
  
  CONCLUSIONS
  Low EF after HT, especially with later onset, is not associated with poor survival and is not related to hemodynamically significant rejection. These data further indicate that the presence of low EF even in the setting of CAD is not by itself an indication for repeat HT.
authors.affiliation: Cardiopulmonary Transplantation Service, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77225-0345, USA. bradovancevic@heart.thi.tmc.edu
authors.forename: Branislav
authors.initials: B
authors.lastname: Radovancevic
authors.forename: Rajko
authors.initials: R
authors.lastname: Radovancevic
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Thomas
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D023921:Coronary Stenosis / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology