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Heterotopic Cervical Heart Transplantation in Mice
Published on: August 25, 2015
Cardiac transplantation in patients with hypertrophic cardiomyopathy
Tomoko S Kato1, Hiroo Takayama, Saeko Yoshizawa
1Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA. rinnko@sannet.ne.jp
Insights
Cardiac transplantation outcomes for hypertrophic cardiomyopathy (HC) patients show promising results. These patients, often younger, experienced better survival rates post-transplant compared to those with ischemic heart disease.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Research
Background:
- Hypertrophic cardiomyopathy (HC) is a significant indication for cardiac transplantation in select patients.
- Pretransplant characteristics and post-transplant prognosis in nondilated idiopathic HC require further elucidation.
- Understanding HC patient profiles is crucial for optimizing cardiac transplant strategies.
Purpose of the Study:
- To compare the clinical course and post-transplant outcomes of patients with idiopathic HC against those with ischemic heart disease and other heart conditions.
- To investigate the impact of left ventricular dimensions on post-transplant survival in HC patients.
- To evaluate the long-term prognosis of cardiac transplantation for hypertrophic cardiomyopathy.
Main Methods:
- Retrospective review of 813 consecutive cardiac transplant recipients at Columbia University Medical Center (1999-2010).
- Comparison of 41 patients with idiopathic HC against 373 with ischemic heart disease and 398 with other heart diseases.
- Analysis of pretransplant characteristics, including ventricular assist device use, and post-transplant survival rates.
Main Results:
- Patients with HC were significantly younger than those with ischemic heart disease (47.8 vs 57.1 years).
- HC patients had lower rates of ventricular assist device use prior to transplantation.
- Post-transplant survival at 1 and 5 years was better for HC patients compared to those with ischemic heart disease (p=0.0359).
Conclusions:
- Cardiac transplantation in patients with hypertrophic cardiomyopathy demonstrates favorable post-transplant survival, particularly when compared to ischemic heart disease.
- Left ventricular end-diastolic dimension did not significantly impact post-transplant survival in this HC cohort.
- The study suggests that HC patients have comparable or better outcomes post-cardiac transplantation than patients with other non-HC indications.
Abstract:
Cardiac transplantation is a treatment option for patients with hypertrophic cardiomyopathy (HC) who developed refractory heart failure and/or intractable arrhythmia. However, the pretransplant characteristics and post-transplant prognosis for patients with nondilated idiopathic HC has not yet fully elucidated. Therefore, we retrospectively reviewed 813 consecutive transplant recipients undergoing cardiac transplantation at Columbia University Medical Center from 1999 to 2010 and compared the clinical course of 41 patients with idiopathic HC with that of 373 patients with ischemic heart disease and 398 patients with other heart disease. The patients with HC were younger than those with ischemic heart disease (47.8 ± 14.0 vs 57.1 ± 9.4 years; p <0.0001). The proportion of patients undergoing ventricular assist devise surgery for bridge-to-transplant was lower in patients with HC than in those with ischemic heart disease or other heart disease (14.6% vs 31.1% vs 35.7%, all p <0.01). The post-transplant survival of those with HC was better than that for those with ischemic heart disease (90.1% vs 85.8% and 83.9% vs 67.1% at 1 and 5 years, respectively; p = 0.0359), although it was not significantly different from those with other heart disease. Proportional hazards analysis revealed that the subjects with HC had reduced post-transplant mortality (hazard ratio 0.4760, 95% confidential interval 0.1889 to 0.9762; p = 0.042) on univariate, but not multivariate, analysis. Most patients with HC had nondilated left ventricles (left ventricular end-diastolic dimension ≤ 55 mm; n = 27), and post-transplant survival did not differ from that for those with dilated left ventricles (left ventricular end-diastolic dimension >55 mm; n = 14). In conclusion, the post-transplant survival of those with HC did not differ from those of the subjects who underwent transplant for other non-HC indications.
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