Prospective validation of right ventricular role in primary graft dysfunction after lung transplantation.
Primary graft dysfunction is a significant cause of lung transplant morbidity and mortality, but its underlying mechanisms are not completely understood. The aims of the present study were: 1) to confirm that right ventricular function is a risk factor for severe primary graft dysfunction; and 2) to propose a clinical model for predicting the development of severe primary graft dysfunction.A prospective cohort study was performed over 14 months. The primary outcome was development of primary graft dysfunction grade 3. An echocardiogram was performed immediately before transplantation, measuring conventional and speckle-tracking parameters. Pulmonary artery catheter data were also measured. A classification and regression tree was made to identify prognostic models for the development of severe graft dysfunction.70 lung transplant recipients were included. Patients who developed severe primary graft dysfunction had better right ventricular function, as estimated by cardiac index (3.5±0.8 versus 2.6±0.7 L·min-1·m-2, p<0.01) and basal longitudinal strain (-25.7±7.3% versus -19.5±6.6%, p<0.01). Regression tree analysis provided an algorithm based on the combined use of three variables (basal longitudinal strain, pulmonary fibrosis disease and ischaemia time), allowing accurate preoperative discrimination of three distinct subgroups with low (11-20%), intermediate (54%) and high (75%) risk of severe primary graft dysfunction (area under the receiver operating characteristic curve 0.81).Better right ventricular function is a risk factor for the development of severe primary graft dysfunction. Preoperative estimation of right ventricular function could allow early identification of recipients at increased risk, who would benefit the most from careful perioperative management in order to limit pulmonary overflow.
Critical Care Dept, Hospital del Mar-Parc de Salut Mar, Institut Mar d'Investigacions mèdiques (IMIM), Barcelona, Spain pperez@parcdesalutmar.cat.|Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Purificación
0000-0001-7042-5758
P
Pérez-Terán
Critical Care Dept, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.|Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
Oriol
0000-0003-3841-4551
O
Roca
Cardiology Dept, Vall d'Hebron University Hospital, VHIR, Barcelona, Spain.
José
J
Rodríguez-Palomares
Critical Care Dept, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.
Juan C
JC
Ruiz-Rodríguez
Critical Care Dept, Hospital del Mar-Parc de Salut Mar, Institut Mar d'Investigacions mèdiques (IMIM), Barcelona, Spain.
Ana
A
Zapatero
Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.|Respiratory Dept, Hospital del Mar-Parc de Salut Mar, IMIM, Barcelona, Spain.|Universitat Pompeu Fabra, Barcelona, Spain.
Joaquim
J
Gea
Critical Care Dept, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.
Joaquim
J
Serra
Cardiology Dept, Vall d'Hebron University Hospital, VHIR, Barcelona, Spain.
Arturo
A
Evangelista
Critical Care Dept, Hospital del Mar-Parc de Salut Mar, Institut Mar d'Investigacions mèdiques (IMIM), Barcelona, Spain.|Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.|Universitat Pompeu Fabra, Barcelona, Spain.
Joan R
JR
Masclans
D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055031:Primary Graft Dysfunction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D016278:Ventricular Function, Right