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Global and regional left ventricular function in heart transplant patients: an angiographic follow-up study
G M Boffa1, R Razzolini, U Livi
1Department of Cardiology, University of Padua Medical School, Italy.
Insights
Left ventricular function in heart transplant recipients shows mild but significant changes over four years post-transplant. While cardiac index and ejection fraction are initially lower, they improve over time, with minor regional wall motion abnormalities noted.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiac Imaging
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Long-term assessment of cardiac function post-transplant is crucial for patient management.
- Understanding the evolution of left ventricular function is key to optimizing outcomes.
Purpose of the Study:
- To evaluate global and regional left ventricular (LV) function over time in heart transplant recipients.
- To identify determinants influencing LV function post-transplantation.
- To assess modifications in LV function at 1, 2, 3, and 4 years after surgery.
Main Methods:
- Retrospective review of left ventricular cineangiography in 50 patients at 1 year, 33 at 2 years, 18 at 3 years, and 7 at 4 years post-transplant.
- Quantitative evaluation of regional wall motion using the area method.
- Exclusion of patients with normal coronary arteries and no acute rejection at the time of study.
Main Results:
- One year post-transplant, cardiac index and LV ejection fraction were mildly reduced but within acceptable limits.
- LV end-diastolic volume increased, and LV mass-volume ratio decreased by year 2.
- By year 3, LV end-diastolic pressure and LV ejection fraction showed increases, with higher heart rates by year 4.
- Previous acute rejection and hypertension influenced LV function; regional hypokinesia was observed in 8 patients at 1 year.
Conclusions:
- Left ventricular function in heart transplant recipients undergoes significant but small absolute value changes over four years.
- While initial function is mildly impaired, it tends to improve, with some patients experiencing regional wall motion abnormalities.
- Factors like prior rejection episodes and hypertension warrant consideration in long-term cardiac surveillance.
Abstract:
We studied the global and regional left ventricular function, its determinants and its modification with time, in orthotopic heart transplant recipients. We reviewed the left ventricular cineangiography performed 1 (50 patients), 2 (33 patients), 3 (18 patients), and 4 (seven patients) years after operation. Regional wall motion was quantitatively evaluated by the area method. All patients had angiographically normal coronary arteries and no evidence of acute rejection at the time of the study. One year after heart transplantation, cardiac index and left ventricular ejection fraction were mildly but significantly lower than normal. Cardiac index was more than 2.5 L/min/m2 in all but one patient, and ejection fraction was more than 50% in all patients. Only previous acute cardiac rejection necessitating therapy and arterial hypertension showed some influence on the left ventricular function. Two years after operation, the left ventricular end-diastolic volume was increased, and left ventricular mass-volume ratio decreased compared with year 1. Three years after operation, an increase of left ventricular end-diastolic pressure and of left ventricular ejection fraction was also evident. Four years after operation, the heart rate was higher, compared with previous years. Even if the changes in the parameters of left ventricular function were significant, they were small in terms of absolute value. Regional hypokinesia was detected 1 year after heart transplantation in eight patients, involving one segment in six patients and two segments in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)