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Right and left ventricular function after cardiac transplantation. Changes during and after rejection
E W Skowronski1, M Epstein, D Ota
1San Diego Cardiac Center, Donald M. Sharp Hospital, CA 92123.
Circulation
|December 11, 1991
Summary
Cardiac transplant rejection causes persistent biventricular diastolic dysfunction, characterized by increased filling pressures and stiffness. This dysfunction, evident even after rejection resolution, suggests potential irreversible changes in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Cardiac Physiology
Background:
- Identifying noninvasive markers for ventricular dysfunction in acute rejection is challenging due to limited hemodynamic data.
- This study aimed to define allograft heart physiology during and after acute rejection.
Purpose of the Study:
- To prospectively monitor detailed hemodynamic parameters in cardiac transplant recipients.
- To correlate hemodynamic changes with acute rejection episodes and their resolution.
Main Methods:
- Serial right heart catheterization and digital image processing in 18 cardiac transplant patients.
- Comparison of hemodynamic states: baseline, rejection, and resolved rejection.
- A control group of 7 non-rejecting transplant recipients was included.
Main Results:
- Acute rejection increased right ventricular pressures and chamber stiffness, while decreasing end-diastolic volumes.
- Diastolic dysfunction persisted even after histological resolution of rejection.
- Elevated systemic vascular resistance and blood pressure were noted post-rejection, associated with increased prednisone dosage.
Conclusions:
- Biventricular diastolic dysfunction may persist post-rejection, potentially due to irreversible effects.
- Changes in left ventricular afterload can complicate serial assessment of ventricular function.
- Findings suggest a restrictive/constrictive physiology during and after rejection.