Pre-existing pulmonary hypertension in patients with end-stage heart failure: impact on clinical outcome and hemodynamic follow-up after orthotopic heart transplantation.
BACKGROUND
The purpose of this investigation was to determine the influence of pre-existing pulmonary hypertension (PHT) on outcome and to assess the pulmonary hemodynamic changes after heart transplantation (HT).


METHODS
A total of 410 patients were studied before and after (1 month and 1 year) HT: Group 1 (n = 266) had no PHT (PVR < 3 Wood units [WU], TPG < 10 mm Hg); Group 2 (n = 112) had mild-moderate PHT (PVR 3 to 6 WU, TPG 10 to 20 mm Hg); and Group 3 (n = 32) had severe PHT (PVR > 6 WU, TPG > 20 mm Hg).


RESULTS
Mean (+/- SD) follow-up was 5.2 +/- 4.1 years, mean recipient age was 57 +/- 11, and mean donor age was 30 +/- 12 years. Baseline characteristics were similar in all groups, except donor/recipient weight ratio, which was higher in patients with PHT (p = 0.002). There was a significant (p < 0.0001) decrease in mean TPG to 11.0 within the first month and to 9.5 mm Hg after the first year. Decreases in PVR to 2.2 and 2.0 WU at 1 month and 1 year, respectively (p < 0.0001 for both) were also found. Reversibility (after vasodilation) of PHT was obtained in 85% of patients in Group 2 and in 84% in Group 3. Patients' PHT did not show a significant difference in 30-day mortality (p = 0.9) and long-term survival (p = 0.8). Patients with residual post-transplant PHT (PVR > or = 3 WU) had reduced long-term survival (p = 0.03). Multivariate analysis showed no evidence that elevated PVR was associated with death.


CONCLUSIONS
Pre-existing elevated PVR that responds to vasodilator challenge does not have a negative influence on short- and long-term survival after HT. We found that residual post-transplant PHT is associated with decreased long-term survival.
Goland
Sorel
S
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Czer
Lawrence S C
LS
Kass
Robert M
RM
De Robertis
Michele A
MA
Mirocha
James
J
Coleman
Bernice
B
Capelli
Christopher
C
Raissi
Sharo
S
Cheng
Wen
W
Fontana
Gregory
G
Trento
Alfredo
A
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008168:Lung / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016019:Survival Analysis; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents