Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?
The natural history of the LV systolic function (LV-SF) and functional capacity of survivors of heart transplantation (Htx) has not been defined. Some investigators suggest that SF may be different in recipients with different pre-transplant aetiologies: ischaemic or dilated, idiopathic disease. Routine transthoracic echocardiograms (TTE) were performed during a 1-year follow-up in 48 Htx recipients (total 864 examinations; mean 18/patient). Patients were divided into two groups based on pre-transplant diagnosis: ischaemic (CAD-CMP: n=13, age 54+/-1.7 years, 23% females) and idiopathic dilated cardiomyopathy (ID-CMP: n=35, age 51+/-2.3 years, 26% females). Patients with valvular and toxic aetiology were excluded. All patients underwent left ventriculography (VENT) 12-15 months after Htx. The majority of 1-year survivors of Htx maintained normal LV-SF: mean LVEF 65+/-4% by echocardiography and 68+/-3% by ventriculography, but in the ID-CMP group LVEF was significantly higher: 67+/-4% vs. 62+/-4% (TTE) and 77+/-4% vs. 60+/-4% (VENT), without significant differences in functional capacity (NYHA). 82.9% of ID-CMP patients had LVEF >65% vs. 39% in CAD-CMP. The incidence of acute cellular rejection, freedom from cardiac vasculopathy, renal failure, diabetes, hypertension and pre-transplant alloantibody level was similar. Our study shows a strong correlation between pre-transplant heart disease and the systolic function of the cardiac allograft at 1-year follow-up.
Antunes
Manuel J
MJ
Program of Heart Transplantation, Centre of Cardiothoracic Surgery, University Hospital, Coimbra, Portugal. antunes.cct.huc@sapo.pt
Biernat
Marta
M
Sola
Emília
E
Oliveira
Luís
L
Prieto
David
D
Franco
Fátima
F
Providência
Luís A
LA
D009202:Cardiomyopathies / Q000150:complications* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000473:pathology / Q000503:physiopathology*; D006085:Graft Survival; D006333:Heart Failure / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left