title: Prognostic value of RV function before and after lung transplantation.
abstract: OBJECTIVE
  We investigated the effects of lung transplantation on right ventricular (RV) function as well as the prognostic value of pre- and post-transplantation RV function.
  
  
  BACKGROUND
  Although lung transplantation success has improved over recent decades, outcomes remain a challenge. Identifying predictors of mortality in lung transplant recipients may lead to improved long-term outcomes after lung transplantation.
  
  
  METHODS
  Eighty-nine (age 60 ± 6 years, 58 men) consecutive patients who underwent single or double lung transplantation and had pre- and post-transplantation echocardiograms between July 2001 and August 2012 were evaluated. Echocardiographic measurements were performed before and after lung transplantation. Left ventricular (LV) and RV longitudinal strains were analyzed using velocity vector imaging. Cox proportional prognostic hazard models predicting all-cause death were built.
  
  
  RESULTS
  There were 46 all-cause (52%) and 17 cardiac (19%) deaths during 43 ± 33 months of follow-up. After lung transplantation, echocardiography showed improved systolic pulmonary artery pressure (SPAP) (50 ± 19 mm Hg to 40 ± 13 mm Hg) and RV strain (-17 ± 5% to -18 ± 4%). No pre-transplantation RV parameter predicted all-cause mortality. After adjustment for age, sex, surgery type, and etiology of lung disease in a Cox proportional hazards model, both post-transplantation RV strain (hazard ratio: 1.13, 95% confidence interval: 1.04 to 1.23, p = 0.005), and post-transplantation SPAP (hazard ratio: 1.03, 95% confidence interval: 1.01 to 1.05, p = 0.011) were independent predictors of all-cause mortality. When post-transplantation RV strain and post-transplantation SPAP were added the clinical predictive model based on age, sex, surgery type, and etiology, the C-statistic improves from 0.60 to 0.80 (p = 0.002).
  
  
  CONCLUSIONS
  Alterations of RV function and pulmonary artery pressure normalize, and post-transplantation RV function may provide prognostic data in patients after lung transplantation. Our study is based on a highly and retrospectively selected group. We believe that larger prospective studies are warranted to confirm this result.
authors.affiliation: Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kusunose
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rayji S
authors.initials: RS
authors.lastname: Tsutsui
authors.affiliation: Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Kavita
authors.initials: K
authors.lastname: Bhatt
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Budev
authors.affiliation: Imaging Institute, Cleveland Clinic, Cleveland, Ohio; Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popović
authors.affiliation: Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.affiliation: Imaging Institute, Cleveland Clinic, Cleveland, Ohio; Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: bolenm@ccf.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bolen
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: echocardiography; lung transplantation; right ventricle