Right heart morphology and function in heart transplantation recipients

Area of Science:

• Cardiology
• Transplant Medicine
• Echocardiography

Background:

• The right heart significantly impacts prognosis in cardiac transplant patients.
• Assessing right ventricular function is crucial for managing these patients.

Purpose of the Study:

• To evaluate right ventricular (RV) morphology and function in heart transplant recipients.
• To determine the relationship between RV parameters and exercise capacity.
• To utilize standard and novel 3D echocardiography for RV analysis.

Main Methods:

• Compared 115 heart transplant recipients with 80 controls using echocardiography and TDI.
• Measured RV dimensions, tricuspid annulus plane systolic excursion (TAPSE), RV systolic velocity (Sm), and 3D RV ejection fraction (RVEF).
• Assessed pulmonary artery pressures and vascular conductance.

Main Results:

• Heart transplant recipients showed increased RV diameters but preserved 3D RVEF.
• TAPSE and Sm were reduced, indicating impaired longitudinal RV function.
• Pulmonary artery systolic pressure (PASP) and vascular conductance (PAVC) were impaired.
• Age at transplant and pulmonary artery pressure independently predicted RV dimensions and RVEF.
• 3D RVEF strongly correlated with functional capacity.

Conclusions:

• RV changes in heart transplant recipients are primarily geometric, not functional, despite reduced longitudinal function.
• Preserved 3D RVEF suggests adaptability of the RV in the long term.
• 3D RVEF is a critical predictor of exercise capacity after heart transplantation.