title: Left and Right Ventricular Functional Dynamics Determined by Echocardiograms Before and After Lung Transplantation.
abstract: Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6% to 41.5 ± 2.7%, RV strain: -15.5 ± 2.9% to -18.0 ± 2.1%, RV E/E': 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%, p = 0.385); however, 20 patients (30%) showed >10% decrease in LVEF after LT (61.5 ± 6.1% to 47.3 ± 4.2%, p <0.001) and an increase in LV E/E' (11.8 ± 1.8 to 12.9 ± 2.2, p = 0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E' was associated with decrease in LVEF after LT (odds ratio 1.381, 95% confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95% confidence interval 1.088 to 1.614, p = 0.002). Although RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York; Heart Center, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: rinnko@sannet.ne.jp.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York.
authors.forename: Hilary F
authors.initials: HF
authors.lastname: Armstrong
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York.
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lippel
authors.affiliation: Heart Center, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York.
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Bartels
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York.
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
mesh_terms: D000328:Adult; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*