title: Echocardiographic assessment of right heart function in heart transplant recipients and the relation to exercise hemodynamics.
abstract: This study aimed to characterize right heart function in heart transplantation (HTx) patients using advanced echocardiographic assessment and simultaneous right heart catheterization (RHC). Comprehensive two-dimensional (2D) and three-dimensional (3D) echocardiographic assessment of right heart function was performed in 105 subjects (64 stable HTx patients and 41 healthy controls). RHC was performed at rest and during semi-supine maximal exercise test. Compared with controls, in conclusion, HTx patients had impaired right ventricle (RV) systolic function in terms of decreased RV-free wall (FW) global longitudinal strain (GLS) (-20 ± 5% vs. -28 ± 5%, P < 0.0001) and 3D-ejection fraction (EF) (50 ± 8% vs. 60 ± 6%, P < 0.0001). In HTx patients, echocardiographic RV systolic function was significantly correlated with NYHA-class (3D-RVEF: r = -0.62, P < 0.0001; RV-FW-GLS: r = -0.41, P = 0.0009) and cardiac allograft vasculopathy (3D-RVEF: r = -0.42, P = 0.0005; RV-FW-GLS: r = -0.25, P = 0.0444). RHC demonstrated a good correlation between invasively assessed resting RV-stroke volume index and exercise capacity (r = 0.58, P < 0.0001) and NYHA-class (r = -0.41, P = 0.0009). RV systolic function is reduced in HTx patients compared with controls. 3D RVEF and 2D longitudinal deformation analyses are associated with clinical performance in stable HTx patients and seem suitable in noninvasive routine right heart function evaluation after HTx. Invasively assessed RV systolic reserve was strongly associated with exercise capacity.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Tor Skibsted
authors.initials: TS
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Eiskjaer
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Brian Bridal
authors.initials: BB
authors.lastname: Løgstrup
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Mads Jønsson
authors.initials: MJ
authors.lastname: Andersen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Mellemkjaer
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Steen Hvitfeldt
authors.initials: SH
authors.lastname: Poulsen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D017023:Coronary Angiography; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006321:Heart; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013599:Systole; D018497:Ventricular Dysfunction, Right
keywords: 3D echocardiography; cardiac allograft vasculopathy; exercise haemodynamics; global longitudinal systolic function; heart transplantation; right ventricular function