Post-Heart Transplant Diastolic Dysfunction Is a Risk Factor for Mortality

Tallaj, José; Kirklin, James K.; Brown, Robert N.; Rayburn, Barry K.; Bourge, Robert C.; Benza, Raymond L.; Pinderski, Laura J.; Pamboukian, Salpy V.; McGiffin, David C.; Naftel, David C.

doi:10.1016/j.jacc.2007.06.007

Cited by 53 publications

(30 citation statements)

References 10 publications

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“…After the first postoperative weeks, the incidence of diastolic dysfunction and elevated filling pressures decrease, and the diastolic dysfunction observed later is likely due to the number of rejection episodes, hypertension, and myocardial ischemia from cardiac allograft vasculopathy. Diastolic dysfunction, especially with right ventricular (RV) involvement occurring in the first year following transplantation and in patients with acute rejection is a known risk factor for increased mortality. Assessment of left ventricular filling pressure by echocardiography in HTx recipients is challenging and the results from studies are conflicting.…”

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confidence: 99%

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

et al. 2014

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Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E' lateral) parameters, and the Doppler-estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E' lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography.

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confidence: 99%

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

et al. 2014

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“…In one study, LV failure after lung transplantation for PH seemed short‐lived, but the response to therapy (inotropic drugs and afterload reduction) varied widely and, in some patients, was delayed by several weeks. Although the physiological situation is very different compared to BLTX, HLTX is also often followed by cardiac dysfunction with PGD . According to our results, we think that HLTX should be done mainly for patients with congenital heart disease (except little interatrial communication which could be surgically fixed) and BLTX for the others.…”

Section: Discussionmentioning

confidence: 77%

Extracorporeal life support in lung and heart–lung transplantation for pulmonary hypertension in adults

Kortchinsky

Mussot

Rezaiguia

et al. 2016

Clinical Transplantation

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After bilateral lung and heart-lung transplantation in adults with pulmonary hypertension, hemodynamic and oxygenation deficiencies are life-threatening complications that are increasingly managed with extracorporeal life support (ECLS). The primary aim of this retrospective study was to assess 30-day and 1-year survival rates in patients managed with vs without post-operative venoarterial ECLS in 2008-2013. The secondary endpoints were the occurrence rates of nosocomial infection, bleeding, and acute renal failure. Of the 93 patients with pulmonary hypertension who received heart-lung (n=29) or bilateral lung (n=64) transplants, 28 (30%) required ECLS a median of 0 [0-6] hours after surgery completion and for a median of 3.0 [2.0-8.5] days. Compared to ECLS patients, controls had higher survival at 30 days (95.0% vs 78.5%; P=.02) and 1 year (83% vs 64%; P=.005), fewer nosocomial infections (48% vs 79%; P=.0006), and fewer bleeding events (17% vs 43%; P=.008). The need for renal replacement therapy was not different between groups (11% vs 17%; P=.54). Venoarterial ECLS is effective in treating pulmonary graft dysfunction with hemodynamic failure after heart-lung or bilateral lung. However, ECLS use was associated with higher rates of infection and bleeding.

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“…[28] As RV diastolic dysfunction is associated with mortality in transplant patients, there appears to be merit in the careful evaluation of biventricular diastolic function in this group. [29]…”

Section: Discussionmentioning

confidence: 99%

Speckle-Tracking Echocardiographic Measures of Right Ventricular Diastolic Function Correlate with Reference Standard Measures Before and After Preload Alteration in Children

et al. 2016

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Background The accuracy of echocardiographic measures of right ventricular (RV) diastolic function has been sparsely studied. Our objective was to evaluate the correlation between echocardiographic and reference standard measures of RV diastolic function derived from micromanometer pressure analysis before and after preload alteration in children. Methods Echocardiograms and micromanometer pressure analyses were prospectively performed before and after fluid bolus in children undergoing right heart catheterization. The isovolumic relaxation time constant (tau) and end-diastolic pressure (EDP) were measured. Conventional and speckle-tracking echocardiographic (STE) parameters of RV systolic and diastolic function were assessed. Normal saline bolus was given to increase RV EDP by 20%. Results 28 studies were performed in 22 patients with congenital heart disease or post heart transplantation. Mean age was 8.7 ± 6.1 yrs. RV longitudinal early diastolic strain rate (EDSR) correlated with tau before (r = 0.57, p = 0.001) and after fluid bolus (r = 0.48, p = 0.008). No conventional echocardiographic measures correlated with tau both before and after fluid bolus. Multiple regression analysis revealed RV EDSR and LV circumferential EDSR as independent predictors of RV tau. There were no independent predictors of EDP. Conclusion RV EDSR appears to correlate with the reference-standard measure of early active ventricular relaxation in children at baseline and after changes in preload. Conventional echocardiographic measures of diastolic function were not predictive of diastolic function after preload alteration. Future studies should assess the prognostic significance of STE measures of diastolic function in this population.

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Post-Heart Transplant Diastolic Dysfunction Is a Risk Factor for Mortality

Cited by 53 publications

References 10 publications

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

Extracorporeal life support in lung and heart–lung transplantation for pulmonary hypertension in adults

Speckle-Tracking Echocardiographic Measures of Right Ventricular Diastolic Function Correlate with Reference Standard Measures Before and After Preload Alteration in Children

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