Pretransplant pulmonary hypertension and long-term allograft right ventricular function.
BACKGROUND
Graft right ventricular (RV) function is compromised directly posttransplant, especially in heart transplantation (HTx) recipients with pretransplant pulmonary hypertension (PH). Graft RV size and systolic function, and the effect of the recipient's pulmonary haemodynamics on the graft extracellular matrix are not well characterised in the patients long-term after HTx.


OBJECTIVE
Comparison of RV size and systolic function in HTx recipients' long-term posttransplant stratified by the presence of pretransplant PH.


METHODS
HTx survivors >or=2 years posttransplant were divided into group I without pretransplant PH (pulmonary vascular resistance, PVR <2.5 Wood units, n=37) and group II with PH (PVR >or=2.5 Wood units, n=16). RV size and systolic function were measured using cardiac magnetic resonance imaging (CMR). The collagen content was assessed in septal endomyocardial biopsies obtained at HTx and at study inclusion.


RESULTS
Mean posttransplant follow-up was 5.2+/-2.9 years (group I) and 4.9+/-2.2 years (group II) (p=0.70). PVR was 1.5+/-0.6 vs 4.1+/-1.7 Wood units pretransplant (p<0.001), and 1.2+/-0.5 vs 1.3+/-0.5 Wood units at study inclusion (p=0.43). Allograft RV size and systolic function were similar in both groups (p always >or=0.07). Collagen content at transplantation and at follow-up were not different (p always >or=0.60).


CONCLUSIONS
Posttransplant normalisation of pretransplant PH is associated with normal graft RV function long-term after HTx.
Department of Cardiology, University Hospital, Bern, Switzerland.
Andreas
A
Wahl
Martin
M
Feller
Eric
E
Wigger
Hildegard
H
Tanner
Christoforos
C
Stoupis
Thierry
T
Carrel
Paul
P
Mohacsi
Roger
R
Hullin
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D003094:Collagen / Q000378:metabolism; D004812:Epidemiologic Methods; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D007165:Immunosuppression Therapy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology*; D016278:Ventricular Function, Right / Q000502:physiology
D003094:Collagen