Usefulness of pulmonary hypertension reversibility test with sodium nitroprusside in stratification of early death risk after orthotopic heart transplantation.
OBJECTIVE
To assess the prognostic value of a PH reversibility test with NPS to predict early death risk after orthotopic heart transplantation (OHT).


METHODS
We analyzed the results of 94 consecutive OHT procedures performed from 2002 to 2003. Pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG) were assessed as part of the routine pre-OHT evaluation. PH was excluded in 57 patients (61%, group A); TPG > or = 12 mmHg and/or PVR > 2.5 Wood units were observed in 37 patients (39%). Sixteen patients underwent a PH reversibility test with NPS: 9 patients (group B) achieved normal TPG and PVR without a drop in systolic arterial pressure (BP(s) > 85 mmHg), while a marked decrease of BP(s) (< 85 mmHg) during NPS infusion was observed in 7 patients (group C). Then, 21 patients were selected for OHT despite PH without any reversibility test. We compared the number of early deaths after OHT among groups (chi-square test).


RESULTS
The 30-day death rate was 7% in group A, 11% in group B, 71% in group C, and 29% in group D. (A vs C, P = .0001 and A vs D, P = .03). Right ventricle or biventricular failure was the cause of death in 1 patient in group A, 1 patient in group B, 5 patients in group C, and 6 patients in group D (A vs C, P < .0001 and A vs D, P = .0012).


CONCLUSIONS
PH reversibility revealed with NPS does not increase the risk of early death after OHT unless there is an absence of marked fall in systemic pressure.
Zakliczynski
M
M
Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Disease, Zabrze, Poland. zaklimed@onet.pl
Zebik
T
T
Maruszewski
M
M
Swierad
M
M
Zembala
M
M
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D005260:Female; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000627:therapeutic use*; D011379:Prognosis; D012306:Risk; D015996:Survival Rate
D000959:Antihypertensive Agents; D009599:Nitroprusside