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Updated: Jul 18, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Echocardiographic evaluation of the evolutionary changes after heart transplantation
L Almenar1, A Osa, L Martínez-Dolz
1Cardiology Department, La Fe University Hospital, Valencia, Spain. lu.almenarb5@comv.es
Insights
Echocardiograms in cardiac transplant patients show early, normalizing changes, including restrictive isovolumetric behavior and right ventricular dysfunction. Late right ventricular malfunction is linked to increased transplant rejection.
Area of Science:
- Cardiology
- Transplant Medicine
- Medical Imaging
Background:
- Cardiac transplantation requires long-term monitoring to assess graft function and detect complications.
- Echocardiography is a key non-invasive tool for evaluating cardiac structure and function post-transplant.
Purpose of the Study:
- To analyze the evolutionary changes in echocardiographic parameters during the follow-up of cardiac transplant recipients.
- To identify early and late echocardiographic alterations and their correlation with clinical outcomes, such as rejection.
Main Methods:
- Analysis of 772 echocardiograms from 193 adult cardiac transplant patients (excluding pediatric, cardiopulmonary, and repeat transplants).
- Four echocardiograms per patient were evaluated: first, second, third quarter, and last study (mean follow-up: 1115 days).
- Key variables included ventricular dimensions, wall thickness, systolic/diastolic function, pericardial effusion, and rejection incidence.
Main Results:
- Isovolumetric relaxation time initially decreased then increased (P < .0001).
- Right ventricular function initially deteriorated but recovered (P < .05), with late dysfunction correlating with higher rejection rates (P < .01).
- Pericardial effusion decreased significantly over time (P < .0001).
Conclusions:
- Cardiac transplant recipients exhibit early echocardiographic alterations that tend to normalize within the first quarter post-transplant.
- Restrictive isovolumetric patterns and impaired right ventricular function are common early changes.
- Late right ventricular malfunction is a significant predictor of transplant rejection during follow-up.
Aim:
To undertake an evolutionary analysis of echocardiographic examinations carried out during follow-up of cardiac transplant patients.
Materials And Methods:
The study included 193 consecutive patients transplanted between August 1998 and December 2004. We excluded pediatric, cardiopulmonary, and repeat transplants. Four echocardiographic examinations were analyzed per patient (first, second, third quarter and the last study carried out; average time from transplant: 1115 +/- 681 days). The total number of examinations was 772. The evaluated variables were thickness of walls and diameters of the cavities, systolic and diastolic functions, pericardial effusion, and number of rejections.
Results:
The isovolumetric relaxation time showed reduced values during early echocardiography with subsequent increases during evolution (first echocardiogram: 92 +/- 16 vs final echocardiogram 101 +/- 16 ms; P < .0001). Right ventricular function showed initial deterioration with subsequent recovery (first echocardiogram: 16% vs final echocardiogram: 8%; P < .05); moreover, the existence of delayed malfunction of the right ventricle was correlated with a higher incidence of transplant rejection (P < .01). Pericardial effusion was initially present with a tendency to reduce over time (first echocardiogram: 58% vs final echocardiogram: 12%; P < .0001). There was no difference in the other variables.
Conclusions:
Cardiac transplant patients undergo evolutionary echocardiogram alterations that were mainly early and normalized as of the first quarter. The most usual changes in this period were restrictive isovolumetric behavior accompanied by some degree of depressed right ventricular function. Right ventricular malfunction during late evolution was correlated with a higher incidence of transplant rejection during follow-up.
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