title: Heart transplantation provides long-term survival benefit in stable patients experiencing heart failure without reverse left ventricular remodeling.
abstract: BACKGROUND
  Heart transplantation does not provide short-term survival benefit in stable patients experiencing chronic heart failure (CHF) with optimized medical therapy. This study compared the outcome of stable patients with CHF with patients after heart transplantation in the long-term.
  
  
  METHODS
  Between January 1995 and September 1997, 318 potential transplant candidates (New York Heart Association class III or IV, left ventricular ejection fraction [LVEF] <35%) were evaluated. After three months of therapeutic optimization, 108 patients were stable outpatients with maximally uptitrated neurohormonal antagonists. Seventy of the 318 patients underwent transplantation between January 1995 and December 1997.
  
  
  RESULTS
  After an observation period of 7 to 10 years, stable patients with CHF had a significantly lower survival compared with transplanted patients (hazard ratio, 0.90; 95% confidence interval, 0.83-0.98; P=0.01). One-year LVEF (> or =30%) was the best independent predictor of long-term survival. Patients with an LVEF > or =30% had a similar survival; patients with an LVEF <30% had a significantly lower survival (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001) compared with transplanted patients.
  
  
  CONCLUSIONS
  Not in the short term (1.5 years) but in the long term (7-10 years), heart transplantation seems to provide survival benefit in stable patients with CHF except in patients with improved LVEF (> or =30%) after medical optimization.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Meyer
authors.forename: Deddo
authors.initials: D
authors.lastname: Moertl
authors.forename: Martin
authors.initials: M
authors.lastname: Huelsmann
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kulemann
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
mesh_terms: D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling