Heart transplantation provides long-term survival benefit in stable patients experiencing heart failure without reverse left ventricular remodeling.
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.
Meyer
Brigitte
B
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Moertl
Deddo
D
Huelsmann
Martin
M
Kulemann
Vanessa
V
Zuckermann
Andreas
A
Grimm
Michael
M
Pacher
Richard
R
Berger
Rudolf
R
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