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Diastolic function after cardiac and heart-lung transplantation
G Hausdorf1, N R Banner, A Mitchell
1Harefield Hospital, Middlesex.
British Heart Journal
|August 1, 1989
Summary
Cardiac transplantation can lead to diastolic dysfunction, affecting left ventricular stiffness and relaxation. Heart-lung transplantation generally preserves normal diastolic function, with impairments linked to donor heart ischemia and age.
Area of Science:
- Cardiology
- Transplant Surgery
- Cardiac Physiology
Background:
- Left ventricular function is crucial for cardiovascular health.
- Understanding post-transplant cardiac mechanics is vital for patient outcomes.
- Diastolic dysfunction can significantly impact heart function after transplantation.
Purpose of the Study:
- To analyze mechanical efficiency, relaxation asynchrony, pressure decay, and stiffness in patients post-cardiac and heart-lung transplantation.
- To identify factors contributing to diastolic dysfunction after cardiac transplantation.
- To compare cardiac function between cardiac transplant and heart-lung transplant recipients.
Main Methods:
- Analysis of left ventricular mechanical efficiency, relaxation, time constant of isovolumic pressure decay, and myocardial stiffness.
- Inclusion of 32 patients: 24 after cardiac transplantation and 8 after heart-lung transplantation.
- Correlation analysis between functional parameters and donor/recipient factors (ischemic time, age, heart size mismatch).
Main Results:
- Increased left ventricular myocardial stiffness and mild incoordinate contraction/relaxation observed after cardiac transplantation.
- Near-normal diastolic function noted in heart-lung transplant recipients.
- Diastolic dysfunction correlated with donor heart ischemic time and donor age.
- Left ventricular asynchrony linked to ischemic time and recipient age.
- No influence of time since transplantation or rejection episodes on diastolic function.
Conclusions:
- Cardiac transplantation is associated with impaired diastolic function, characterized by increased myocardial stiffness.
- Donor heart ischemic time and donor age are significant factors in post-cardiac transplant diastolic dysfunction.
- Heart-lung transplantation appears to better preserve diastolic function compared to isolated cardiac transplantation.
- Donor-recipient heart size mismatch may also contribute to diastolic impairment.