Clinical features, exercise hemodynamics, and determinants of left ventricular elevated filling pressure in heart transplanted patients

Keywords:

  • heart transplantation;
  • cardiac allograft vasculopathy;
  • positron emission tomography;
  • haemodynamics;
  • global longitudinal systolic function

Abstract

Purpose

This study aimed to assess clinical, functional, and hemodynamic characteristics of heart-transplanted (HTX) patients during exercise.

Methods

We performed comprehensive echocardiographic graft function assessment during invasive hemodynamic semi-supine exercise test in 57 HTX patients. According to hemodynamics findings, patients were divided into: Group A: Normal left ventricular (LV) filling pressure (FP): Pulmonary capillary wedge pressure (PCWP) <15mmHg at rest and <25mmHg at peak exercise; Group B: Elevated LV-FP: PCWP≥15mmHg at rest or ≥25mmHg at peak exercise.

Results

Thirty-one patients (54%) had normal LV-FP and 26 patients (46%) had elevated LV-FP. The latter had higher cumulative rejection burden (p<0.01), were more symptomatic (NYHA class >1) (p<0.05), and CAV was more prevalent (p<0.05). With exercise, the changes in both left and right sided filling pressures were significantly increased, whereas LV longitudinal myocardial deformation was lower (p<0.05) in patients with elevated LV-FP than in patients with normal LV-FP. No between-group difference was observed for cardiac index or LV ejection fraction (LVEF) during exercise.

Conclusion

Elevated LV-FP can be demonstrated in approximately 50% of HTX patients. Patients with elevated LV-FP have impaired myocardial deformation capacity, higher prevalence of CAV, higher rejection burden, and were more symptomatic. Exercise test with assessment of longitudinal myocardial deformation should be considered in routine surveillance of HTx patients as a marker of restrictive filling.

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Autor / Fonte:Tor Skibsted Clemmensen, Hans Eiskjaer, Brian Bridal Løgstrup, Søren Mellemkjaer, Mads Jønsson Andersen, Lars Poulsen Tolbod, Hendrik J Harms, Steen Hvitfeldt Poulsen Transplant International: Official Journal of the European Society for Organ Transplanta
Link: http://onlinelibrary.wiley.com/doi/10.1111/tri.12690/abstract