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Hemodynamic abnormalities following cardiac transplantation: relationship to hypertension and survival
S Murali1, B F Uretsky, P S Reddy
1Department of Medicine, University of Pittsburgh School of Medicine, PA.
Insights
Hemodynamic abnormalities after heart transplant are linked to high blood pressure and often resolve. These changes do not appear to impact survival in the first three years post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Nephrology
Background:
- Orthotopic heart transplantation (OHT) recipients often develop hemodynamic abnormalities.
- Post-transplant hypertension is a common complication affecting long-term outcomes.
Purpose of the Study:
- To evaluate the prevalence and long-term implications of hemodynamic abnormalities one year after OHT.
- To investigate the relationship between these abnormalities and post-transplant hypertension.
Main Methods:
- Prospective evaluation of 82 asymptomatic OHT recipients on cyclosporine and prednisone.
- Annual cardiac catheterization to assess hemodynamic parameters including left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and LVEDP-volume ratio (R).
- Monitoring of mean systemic arterial pressure (MAP) and patient survival.
Main Results:
- Abnormal LVEDP (27%), EF (14%), and R (23%) were prevalent at one year post-transplant.
- Patients with abnormal LVEDP or R exhibited higher MAP.
- Changes in hemodynamic status (normalization or development of abnormalities) correlated with significant decreases or increases in MAP, respectively.
- Hemodynamic abnormalities at one year did not correlate with poorer survival.
Conclusions:
- Hemodynamic abnormalities in asymptomatic OHT recipients are associated with post-transplant hypertension.
- These abnormalities appear to be dynamic and related to blood pressure control.
- The presence of these abnormalities within the first three years does not indicate an adverse prognosis.
Abstract:
The prevalence and long-term implications of hemodynamic abnormalities seen at 1 year following orthotopic heart transplantation and their relationship to post-transplant hypertension were prospectively evaluated in 82 consecutive asymptomatic recipients taking cyclosporine and prednisone who underwent annual catheterization. Abnormal left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and left ventricular end-diastolic pressure-volume ratio (R) were the most prevalent hemodynamic abnormalities (27%, 14%, and 23%, respectively, at 1 year). Patients with abnormal LVEDP or R had higher (p less than 0.05) mean systemic arterial pressure (MAP). During follow-up, hemodynamic abnormalities disappeared in some patients while they developed in some others. Transplant patients with abnormal LVEDP, EF, or R at 1 year who normalized at 2 years had a significant (p less than 0.05) decrease in MAP. Likewise, patients with normal LVEDP, EF, or R at 1 year who subsequently developed abnormalities had a significant (p less than 0.05) increase in MAP. The presence of hemodynamic abnormalities at 1 year was not associated with a poorer survival (mean follow-up 2.6 +/- 1.1 years). In summary, hemodynamic abnormalities in asymptomatic transplant recipients taking cyclosporine and prednisone appear to be related to the level of post-transplant hypertension and do not signify an adverse prognosis over the first 3 years.