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Diastolic function in heart transplant: From physiology to echocardiographic assessment and prognosis
Carlotta Sciaccaluga1, Chiara Fusi1, Federico Landra1
1Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
Insights
Heart transplant (HTx) patients have unique heart physiology affecting diastolic function. Standard echocardiography may misinterpret graft function, necessitating a specialized approach for accurate assessment.
Area of Science:
- Cardiology
- Transplant Medicine
- Echocardiography
Background:
- Heart transplantation (HTx) is the primary treatment for end-stage heart failure, offering a median survival of 10 years.
- Post-transplant cardiac physiology differs significantly from the native heart due to surgical alterations.
- Diastolic function, particularly left atrial (LA) function, is crucial but altered in HTx recipients.
Purpose of the Study:
- To review current evidence on diastolic function in heart transplant recipients.
- To explain the unique physiology of the transplanted heart and its impact on echocardiographic parameters.
- To propose an algorithm for distinguishing true diastolic dysfunction from normal patterns in HTx.
Main Methods:
- Literature review of current evidence on diastolic function in HTx.
- Analysis of how standard echocardiographic parameters are affected in the transplanted heart.
- Development of a clinical algorithm based on center experience and existing data.
Main Results:
- Transplanted hearts exhibit altered diastolic function, influenced by surgical techniques.
- Standard echocardiographic assessments may not accurately reflect diastolic function in HTx patients.
- A proposed algorithm aims to aid in the correct interpretation of diastolic patterns.
Conclusions:
- Diastolic function assessment in HTx requires consideration of unique graft physiology.
- Traditional echocardiographic methods may be insufficient for evaluating diastolic function in HTx.
- A tailored approach and diagnostic algorithm are essential for managing HTx patients.
Abstract:
Heart transplant (HTx) still represents the most effective therapy for end-stage heart failure, with a median survival time of 10 years. The transplanted heart shows peculiar physiology due to the profound alterations induced by the operation, which inevitably influences several echocardiographic parameters assessed during these patients' follow-ups. With these premises, the diastolic function is one of the main aspects to take into consideration. The left atrium (LA) plays a key role in this matter, and that same chamber is significantly impaired with the transplant, with different degrees of altered function based on the surgical technique. Therefore, the traditional echocardiographic evaluation of diastolic function applied to the general population might not properly reflect the physiology of the graft. This review attempts to provide current evidence on diastolic function in HTx starting from defining its different physiology and how the standard echocardiographic parameters might be affected to its prognostic role. Furthermore, based on the experience of our center and the available evidence, we proposed an algorithm that might help clinicians distinguish from actual diastolic dysfunction from a normal diastolic pattern in HTx population.
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