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Differences in clinical profile and survival after heart transplantation according to prior heart disease
J Agüero1, L Almenar, L Martínez-Dolz
1Heart Failure and Transplant Unit, Cardiology Department, La Fe University Hospital, Valencia, Spain. jaimeaguero30@hotmail.com
Insights
Patients with idiopathic dilated cardiomyopathy (IDC) had better long-term survival after heart transplantation (HT) compared to those with ischemic or valvular heart disease. Early survival rates were similar across all groups. This highlights differences in pretransplant profiles and outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation (HT) is a life-saving procedure for end-stage heart failure.
- Patient outcomes after HT can be influenced by the underlying etiology of heart disease.
- Comparing survival based on pretransplant heart disease is crucial for optimizing patient management.
Purpose of the Study:
- To compare baseline characteristics and long-term survival of heart transplant recipients based on three primary pretransplant heart disease types: ischemic heart disease, idiopathic dilated cardiomyopathy (IDC), and valvular heart disease.
- To identify potential differences in patient profiles and post-transplant outcomes among these groups.
Main Methods:
- A retrospective analysis of 423 heart transplantations performed between 1989 and 2005.
- Exclusion of pediatric, retransplantation, combined, and other specific heart disease cases.
- Statistical analysis included ANOVA, chi-square tests, Kaplan-Meier survival curves, log-rank tests, and multivariate logistic regression.
Main Results:
- Ischemic and valvular heart disease groups were older with more prior surgeries and circulatory support compared to the IDC group.
- No significant differences in 30-day survival rates were observed across the three groups (88% ischemic, 93% IDC, 84% valvular).
- Long-term survival was significantly higher in the IDC group (75%) compared to valvular (65%) and ischemic (62%) groups (P=.021), with IDC associated with better survival (OR, 0.55; P=.015).
Conclusions:
- Patients undergoing heart transplantation exhibit distinct clinical profiles based on their pretransplantation heart disease.
- Early mortality rates post-heart transplantation do not differ significantly among patients with ischemic, IDC, or valvular heart disease.
- Idiopathic dilated cardiomyopathy recipients demonstrate superior long-term survival following heart transplantation compared to those with ischemic or valvular heart disease.
Objective:
The objective of this study was to compare baseline characteristics and long-term survival among patients undergoing heart transplantation (HT) according to the 3 main types of prior heart disease: ischemic, idiopathic dilated cardiomyopathy (IDC), and valvular.
Materials And Methods:
Four hundred twenty-three HTs performed between 1989 and 2005 were included. We excluded pediatric transplantation, retransplantations, combined transplantations (lung and kidney), and transplantations due to heart diseases other than ischemic, IDC, and valvular. Baseline characteristics of the recipients were analyzed, as well as short-term and long- term survival by groups. Analysis of variance (ANOVA) was used for continuous variables and chi-square was used for categorical variables. Survival analysis was computed using Kaplan-Meier curves and the log-rank test, as well as multivariate analysis using logistic regression.
Results:
The ischemic and valvular heart disease groups were older and had a more frequent history of prior heart surgery and circulatory support at the time of transplantation compared with the IDC group. The incidence of arterial hypertension and dyslipidemia was higher among ischemic heart disease recipients. Survival rates at 30 days did not show significant differences (ischemic, 88%; IDC, 93%; and valvular; 84%; P = .21). Long-term survival rates were greater in the IDC than in the valvular or ischemic heart disease groups (75% vs 65% and 62%, respectively; P = .021). The multivariate analysis showed an association between the IDC group and long-term survival (odds ratio [OR], 0.55; 95% confidence interval [CI] 0.35-0.89; P = .015).
Conclusions:
(1) Patients showed a different clinical profiles depending on their pretransplantation heart disease. (2) There were no differences in early mortality between the groups. (3) Long-term survival was significantly greater among IDC transplant recipients and similar in ischemic and valvular heart disease transplant recipients.
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