title: Chronic heart failure in heart transplant recipients: Presenting features and outcome.
abstract: BACKGROUND
  The ageing graft frequently shows coronary lesions and a restrictive physiology.
  
  
  OBJECTIVE
  To determine the presenting features and outcome of chronic heart failure in heart transplant recipients.
  
  
  METHODS
  In this cohort study, we compared 44 consecutive heart transplant recipients who developed chronic heart failure more than 1 year after heart transplantation with 44 control heart transplant recipients who did not develop heart failure.
  
  
  RESULTS
  We found that patients who developed heart failure had more frequently a history of hypertension or diabetes before transplantation. During the 12 months after transplantation, significantly more patients had moderate-to-severe acute rejections (≥ grade 2R) in the heart failure group than in the control group. At the time of heart failure diagnosis, systolic left ventricular function was preserved in 50% of patients and coronary angiography was normal or near normal in 36% of patients. Half of the 44 patients in the heart failure group died within 2 years of heart failure diagnosis. Ascites and end-stage renal failure requiring dialysis were significantly more frequent during follow-up in the heart failure group than in the control group (respectively, 10/44 vs 0/44 [P=0.001] and 18/44 vs 5/44 [P=0.003]).
  
  
  CONCLUSIONS
  In heart transplant recipients presenting with heart failure, systolic left ventricular function is frequently preserved and coronary angiography is frequently abnormal, but may be normal or near normal. During follow-up, the main features of these patients are a high mortality rate after heart failure diagnosis, a frequent need for renal dialysis and frequent ascites.
authors.affiliation: Department of cardiology, La Timone hospital, Aix-Marseille university, rue Saint-Pierre, 13385 Marseille, France. Electronic address: pierre.ambrosi@ap-hm.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ambrosi
authors.affiliation: Department of cardiac surgery, La Timone hospital, Aix-Marseille university, 13385 Marseille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Kreitmann
authors.affiliation: Department of cardiac surgery, La Timone hospital, Aix-Marseille university, 13385 Marseille, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.affiliation: Department of cardiology, La Timone hospital, Aix-Marseille university, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lambert
authors.affiliation: Department of cardiology, La Timone hospital, Aix-Marseille university, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pankert
authors.affiliation: Department of cardiology, La Timone hospital, Aix-Marseille university, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
mesh_terms: D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Heart failure; Heart transplantation; Insuffisance cardiaque; Rejection; Rejet; Transplantation cardiaque