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Post-heart transplant diastolic dysfunction is a risk factor for mortality

José A Tallaj1, James K Kirklin, Robert N Brown

  • 1Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA. jtallaj@uab.edu

Journal of the American College of Cardiology
|September 11, 2007
PubMed

Insights

Diastolic dysfunction is common after heart transplants, decreasing over the first year. Right ventricular diastolic dysfunction, indicated by an elevated right atrial pressure/stroke volume ratio, predicts cardiac mortality, unlike left ventricular diastolic dysfunction.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Cardiac Physiology

Background:

  • Diastolic dysfunction (DD) is a known complication post-heart transplant.
  • Its incidence and natural history require further characterization.
  • This study investigates the prognostic significance of early post-transplant DD.

Purpose of the Study:

  • To determine the incidence of diastolic dysfunction within the first year after heart transplantation.
  • To evaluate the prognostic implication of early diastolic dysfunction on cardiac mortality.

Main Methods:

  • A cohort of 231-250 heart transplant recipients were assessed at 6 weeks, 6 months, and 1 year post-transplant.
  • Diastolic dysfunction was defined by elevated filling pressures (RAP >/=15 mm Hg or PCWP >/=18 mm Hg) with preserved systolic function.
  • Right ventricular DD was specifically assessed using the RAP/SV ratio.

Main Results:

  • The incidence of DD was 22% at 6 weeks, decreasing to 8% at 6 months and 12% at 1 year.
  • Left ventricular DD was more prevalent than right ventricular DD.
  • Elevated RAP/SV ratio (RV DD) strongly predicted cardiac mortality, whereas LV DD did not.

Conclusions:

  • Diastolic dysfunction is a frequent early complication after heart transplantation, with incidence declining over the first year.
  • Right ventricular DD, identified by an elevated RAP/SV ratio, is a significant predictor of cardiac mortality.
  • Further research is needed to assess patient functional status and the impact of early DD treatment on outcomes.
Abstract

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