title: Pulmonary hypertension in heart transplantation: discrepant prognostic impact of pre-operative compared with 1-year post-operative right heart hemodynamics.
abstract: BACKGROUND
  The prognostic impact of pulmonary hypertension (PH) before and after heart transplantation (HTx) is debated. We investigated: (i) the significance of pre-operative reversible PH on post-operative survival; (ii) the value of recatheterization while on the waiting list; (iii) the evolution of right heart hemodynamics (RHH) after HTx; and (iv) the prognostic impact of PH at 1 year after HTx.
  
  
  METHODS
  We reviewed the records of 500 HTx recipients transplanted between 1983 and 2007. Pre-operatively, a non-PH group (Group 1, n = 365) fulfilled directly our RHH criteria for HTx, while a PH group (Group 2, n = 135) was accepted after reversibility of PH by acute vasodilatory testing. Recatheterization was performed every third month while on the waiting list and repeatedly after transplantation.
  
  
  RESULTS
  With a follow-up of 6.8 +/- 5.1 years and a 50% survival rate of 12.1 +/- 5.4 years, our main findings were as follows: (i) Patients with reversible PH on vasodilatory testing had a survival rate similar to that of patients without PH (11.7 +/- 0.8 vs 12.1 +/- 0.5 years, p = 0.80). (ii) Pre-operative recatheterization was of limited value as RHH remained stable. Five percent of patients died while on the waiting list and 2 improved clinically and were removed. (iii) Mean pulmonary artery pressure (MAP) was reduced from 28 +/- 9 and 40 +/- 8 mm Hg pre-operatively to 21 +/- 7 and 24 +/- 6 mm Hg after 2 weeks and 16 +/- 7 and 18 +/- 8 mm Hg at 3 years in Groups 1 and 2, respectively. (iv) Recipients with MAP >20 mm Hg at 1 year post-HTx had significantly lower survival than those with MAP <or=20 mm Hg (11.5 +/- 0.7 vs 15.6 +/- 0.6 years, p < 0.001).
  
  
  CONCLUSIONS
  Elevated pulmonary pressure 1 year after HTx provides significant prognostic information regarding long-term outcome, whereas pre-operative reversible PH in this group does not influence survival.
authors.affiliation: Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. einar.gude@rikshospitalet.no <einar.gude@rikshospitalet.no>
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
authors.forename: Svein
authors.initials: S
authors.lastname: Simonsen
authors.forename: Odd R
authors.initials: OR
authors.lastname: Geiran
authors.forename: Arnt E
authors.initials: AE
authors.lastname: Fiane
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.forename: Satish
authors.initials: S
authors.lastname: Arora
authors.forename: Anne
authors.initials: A
authors.lastname: Relbo
authors.forename: Arne K
authors.initials: AK
authors.lastname: Andreassen
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis*