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Clinical and hemodynamic profile of patients with advanced heart failure considered for heart transplantation
V Ortiz1, L Martínez-Dolz, E Sánchez-Lacuesta
1Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain. vortiz@comv.es
Insights
Patients undergoing heart transplantation (HT) show similar clinical and hemodynamic profiles regardless of prior heart disease. Strict transplant criteria may homogenize patient characteristics before advanced heart failure treatment.
Area of Science:
- Cardiology
- Transplantation Medicine
Background:
- Advanced heart failure necessitates evaluation for heart transplantation (HT).
- Prior cardiac disease may influence pre-transplant clinical and hemodynamic status.
- Understanding these differences is crucial for optimizing HT candidacy.
Purpose of the Study:
- To evaluate the clinical and hemodynamic status of advanced heart failure patients considered for HT.
- To investigate the impact of underlying cardiac disease (ischemic heart disease, dilated cardiomyopathy, valvular disease) on pre-transplant parameters.
Main Methods:
- Analysis of pre-transplant clinical, echocardiographic, and hemodynamic data from 422 HT patients.
- Exclusion of pediatric, heart-lung, and re-transplant cases.
- Comparison of patient groups based on the etiology of heart failure: ischemic heart disease (IHD), dilated cardiomyopathy (DMC), or valvular disease.
Main Results:
- Baseline characteristics varied: IHD patients more frequently male with hypertension and diabetes; DMC patients were younger.
- No significant differences observed in clinical parameters (liver/kidney function, functional class, inotropic support).
- Hemodynamic parameters (pulmonary pressures, resistance) and echocardiographic findings (ventricular size, ejection fraction) showed variations, particularly greater ventricular dimensions and reduced ejection fractions in DMC patients.
Conclusions:
- Patients with advanced heart failure awaiting HT exhibit comparable clinical and hemodynamic profiles irrespective of the underlying cardiac disease.
- Strict selection criteria for heart transplantation may lead to a homogeneous group of candidates.
- These findings suggest that the severity of heart failure, rather than its etiology, dictates the pre-transplant status in this highly selected cohort.
Introduction:
The present study evaluated the clinical and hemodynamic situation of patients with advanced heart failure considered for heart transplantation (HT) to examine the possible impact of prior cardiac disease.
Methods:
We analyzed the pretransplant clinical, echocardiographic, and hemodynamic parameters of 422 consecutive HT patients. Pediatric and heart plus lung transplants were excluded, as were retransplantations. The results were compared by dividing the patients into three groups according to the background heart disease that led to HT: ischemic heart disease (IHD), dilated myocardiopathy (DMC), or valvular disease.
Results:
Differences were observed in the baseline characteristics according to the type of heart disease. Male gender, hypertension, and diabetes were more frequent among IHD, while DMC patients tended to be younger. There were no differences in the clinical parameters such as liver and kidney function, in the functional class, or in the need for inotropic treatment over the days prior to transplantation. Likewise, no differences were recorded in the hemodynamic parameters, such as pulmonary pressure, pulmonary vascular resistance, or transpulmonary pressure gradient. As regards the echocardiographic parameters, the patients with DMC showed greater ventricular diameters and lesser ejection fractions for both ventricles.
Conclusion:
No important differences were recorded in the clinical situation or hemodynamic parameters of patients with advanced heart failure accepted for transplantation, according to the background cardiac disease. This observation could be due to the homogenization by strict transplant waiting list inclusion criteria.
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