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Updated: Jun 1, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Changes in left and right ventricular function of donor hearts during the first year after heart transplantation
Sorel Goland1, Robert J Siegel, Kevin Burton
1Heart Institute, Kaplan Medical Center, Rehovot 76100, Israel. sorelgoland@yahoo.com
Insights
Tissue Doppler Imaging (TDI) and myocardial performance index (MPI) reveal early bi-ventricular dysfunction after heart transplantation (HTx), with gradual improvement over the first year. Fibrosis increased substantially, despite preserved myocyte size.
Area of Science:
- Cardiovascular Medicine
- Transplant Cardiology
- Echocardiography
Background:
- Expected values for Tissue Doppler Imaging (TDI) velocities and myocardial performance index (MPI) post-heart transplantation (HTx) are not well-established.
- Assessing left and right ventricular (LV and RV) function is crucial for managing HTx recipients.
Purpose of the Study:
- To evaluate the expected changes in TDI velocities and MPI in both ventricles during the first year after HTx.
- To assess LV and RV structure and function using TDI and MPI in the initial year post-transplant.
Main Methods:
- Echocardiography, including MPI and TDI (S', E', A' velocities), was performed serially in 20 HTx recipients over the first year.
- Measurements were compared between donors and recipients, and over time within recipients.
Main Results:
- An early increase in LV mass was observed, normalizing by 3 months.
- MPI increased, and TDI velocities (E', S') decreased at week 1, with gradual improvement throughout the year.
- While MPI normalized by 6 months and LV TDI velocities by 1 year, overall TDI velocities remained lower than baseline; significant fibrosis increased by 3.3-fold.
Conclusions:
- This study provides the first normative data for TDI and MPI in both ventricles during the first year post-HTx.
- Early post-HTx, recipients experience increased LV mass and impaired bi-ventricular systolic and diastolic function, which gradually improve.
- Despite preserved myocyte size, a substantial increase in cardiac fibrosis occurs within the first year, highlighting potential long-term structural changes.
Objective:
Expected values of tissue Doppler imaging (TDI) velocities and myocardial performance index (MPI) after heart transplantation (HTx) have not been evaluated. This study assessed left and right ventricular (LV and RV) structure and function during the first year after HTx using these indexes.
Methods And Results:
Echocardiography including MPI and TDI systolic (S'), early (E') and late (A') diastolic velocities of RV and LV were performed in 20 donors (mean age 35 ± 13 years) and serially in 20 recipients (mean age 59 ± 9 years) during the first year after HTx. Increase in LV mass occurred at 7 days, with normalisation at 3 months (p < 0.001). An increase in MPI (p<0.001) and a decrease in E', S' velocities on TDI occurred at week 1 with gradual improvement during the first year (p < 0.001). Normalisation of LV and RV MPI occurred at 6 months (p < 0.001) and LV TDI velocities at 1 year (p < 0.001). TDI velocities of both ventricles, however, at 1 year remained lower than at baseline. No patient had greater than grade IA rejection during the follow-up. No significant change was found in myocyte size within the first year. However, there was a 3.3-fold increase in fibrosis.
Conclusions:
This study is the first to identify the normal changes of TDI and MPI of both ventricles during the first year after HTx. An increase in LV mass and impairment of bi-ventricular systolic and diastolic function occur early after HTx with gradual improvement during the first year. No significant changes in myocyte size were observed, but there was a substantial increase in fibrosis.
