Diastolic Dysfunction of the Cardiac Allograft and Maximal Exercise Capacity

Roten, Laurent; Schmid, J; Merz, Franziska; Carrel, Thierry; Zwahlen, Marcel; Walpoth, Nazan; Mohaçsi, Paul; Hullin, Roger

doi:10.1016/j.healun.2008.12.001

Cited by 24 publications

(27 citation statements)

References 30 publications

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“…Abbreviations as in Tables 2 and 3. companied by PCWP elevation 23,24,27,31,[33][34][35][36] . Impaired LV diastolic function in heart transplant recipients was found even if LVEF was normal 30,32 and if there was no or only 1A myocardial rejection 30 . Diastolic dysfunction was attributed to both the worsening of relaxation 37 and an increase in myocardial stiffness 22,35 .…”

Section: Left Ventricular Diastolic Dysfunction In Patients After Ortmentioning

confidence: 99%

High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Meluzı́n¹,

Hude²,

Leinveber³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. Post-heart transplant patients are at increased risk of diastolic dysfunction. The aim of this study was to assess the prevalence of isolated only exercise-induced heart failure with normal ejection fraction (HFNEF) in heart transplant recipients. Methods and Results. To determine pulmonary capillary wedge pressure (PCWP) at rest and during exercise, 81 patients after orthotopic heart transplantation with normal left ventricular ejection fraction (LVEF) underwent exercise right heart catheterization with simultaneous exercise echocardiography. Based on PCWP values, the patients were divided into three groups. Twenty-one patients had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise < 25 mmHg, prevalence 26%). Forty-seven subjects were found to have only exercise-induced HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise ≥ 25 mmHg, prevalence 58%). Thirteen patients had HFNEF already at rest (PCWP ≥ 15 mmHg at rest, prevalence 16%). Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF. Conclusions. In heart transplant recipients with normal LVEF, there is a high prevalence of exercise-induced HFNEF. LV mass index adjusted for allograft age is predictive of exercise-induced HFNEF.

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Section: Left Ventricular Diastolic Dysfunction In Patients After Ortmentioning

confidence: 99%

High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Meluzı́n¹,

Hude²,

Leinveber³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…There are multiple factors that could affect exercise performance after heart HTx and these include recipient’s age, gender, body mass index (BMI),(6) chronotropic incompetence, (5, 7) diastolic dysfunction,(5, 8) defective adrenergic signaling, altered intracellular calcium handling,(9–11) transplant vasculopathy,(12) endothelial dysfunction(13) and skeletal muscle abnormalities. (11, 14, 15)…”

Section: Introductionmentioning

confidence: 99%

Cardiac allograft hypertrophy is associated with impaired exercise tolerance after heart transplantation

Raichlin

Al‐Omari

Hayes

et al. 2011

The Journal of Heart and Lung Transplantation

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Background Exercise performance, an important aspect of quality of life, remains limited after heart transplantation (HTx). This study examines the effect of cardiac allograft remodeling on functional capacity after HTx. Methods The total cohort of 117 HTx recipients based on echocardiographic determination of left ventricle mass and relative wall thickness at 1 year after HTx, was divided into 3 groups: (1) NG - normal geometry (2) CR - concentric remodeling and (3) CH - concentric hypertrophy. Cardiopulmonary exercise testing was performed 5.03±3.08 years after HTx in all patients. Patients with acute rejection or significant graft vasculopathy were excluded. Results At 1 year after HTx, 30% patients had CH, 55% had CR and 15% demonstrated NG. Exercise tolerance measured by maximum achieved metabolic equivalents (4.62±1.44vs.5.52±0.96 kcal/kg/h), normalized peak VO2 (52±14% vs. 63±12%) and VE/VCO2 (41±17 vs. 34±6) were impaired in the CH group compared to the NG group. A peak VO2≤14 ml/kg/min was found in 6%, 22% and 48% in the NG, CR and CH groups respectively (p=0.01). The CH pattern was associated with a 7.4 – fold increase in relative risk for a peak VO2≤14 ml/kg/min as compared to NG patients (95% CI 1.1 – 51.9, p=0.001). After multivariable analysis, a 1-year CH pattern was independently associated with reduced normalized peak VO2 (p=0.018) and an elevated VE/VCO2 (p=0.035). Conclusion The presence of CH one year after HTx is independently associated with decreased normalized peak VO2 and increased ventilatory response in stable heart transplant recipients. The identification of CH, a potentially reversible mechanism of impairment in exercise capacity after HTx, could have important clinical implications.

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“…4 Exercise capacity in HTx patients is usually limited to~50-70% of the age-predicted value despite normal left ventricular ejection fraction (LVEF) and it is independent of the presence of macrovascular CAV. [10][11][12] Several factors potentially influence exercise capacity in HTx patients. These factors include heart denervation, myocardial hypertrophy, myocardial fibrosis, diastolic dysfunction, and CAV.…”

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confidence: 99%

Coronary Flow Reserve Predicts Longitudinal Myocardial Deformation Capacity in Heart‐Transplanted Patients

et al. 2015

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Diastolic Dysfunction of the Cardiac Allograft and Maximal Exercise Capacity

Cited by 24 publications

References 30 publications

High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Cardiac allograft hypertrophy is associated with impaired exercise tolerance after heart transplantation

Coronary Flow Reserve Predicts Longitudinal Myocardial Deformation Capacity in Heart‐Transplanted Patients

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