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Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation
1Heart Failure and Transplant Center, Hahnemann University, Philadelphia, Pennsylvania 19102-1192.
Insights
Right atrial pressure is the strongest predictor of survival for patients awaiting heart transplantation. A hemodynamic risk score also helps identify high-risk individuals, guiding transplant candidacy.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Patients awaiting cardiac transplantation face long waiting periods for donor organs.
- Identifying high-risk patients before transplantation is crucial for resource allocation and patient management.
- Existing hemodynamic parameters have not consistently predicted survival in this cohort.
Purpose of the Study:
- To evaluate the predictive value of hemodynamic abnormalities for 1-year survival in patients listed for cardiac transplantation.
- To determine if a composite hemodynamic risk score (HRS) improves risk stratification compared to individual parameters.
Main Methods:
- A retrospective analysis of 138 consecutive patients listed for cardiac transplantation.
- Patients were grouped based on a hemodynamic risk score (HRS) derived from right atrial pressure, pulmonary artery systolic pressure, transpulmonary gradient, cardiac output, cardiac index, and pulmonary vascular resistance.
- One-year survival rates were compared across different HRS groups and by individual hemodynamic parameters.
Main Results:
- Right atrial pressure was the most significant predictor of 1-year survival (p < 0.05).
- Patients with right atrial pressure > 12 mm Hg had a 47% 1-year survival, versus 68% for those with pressure < 12 mm Hg.
- The hemodynamic risk score (HRS) was the next strongest predictor; Group III (HRS = 4-6) had significantly lower 1-year survival (41%) compared to Groups I and II (66-69%, p < 0.03).
Conclusions:
- Right atrial pressure is a key independent predictor of short-term mortality in patients awaiting cardiac transplantation.
- A hemodynamic risk score incorporating multiple hemodynamic parameters offers valuable risk stratification for this population.
- These findings can aid in identifying patients most in need of urgent transplantation or alternative interventions.
Abstract:
A profile of hemodynamic abnormalities in patients listed for cardiac transplantation was related to survival during the first year after listing. After a patient is listed for cardiac transplantation, the waiting period for a suitable donor heart is often long; therefore, objective criteria to determine risk would be helpful in identifying the group at highest risk of dying before receiving a transplant. Several studies have suggested certain hemodynamic parameters to be related to a poor prognosis. However, no 1 variable has emerged as an adequate predictor of survival in patients awaiting cardiac transplantation. One-year outcomes were examined in 138 consecutive patients listed for cardiac transplantation, who were grouped according to a hemodynamic risk score (HRS) based on abnormalities in baseline measures of right atrial pressure, pulmonary artery systolic pressure, transpulmonary gradient, cardiac output, cardiac index and pulmonary vascular resistance. Right atrial pressure alone was the most significant predictor of survival (p < 0.05). Patients with a right atrial pressure > 12 mm Hg had a 47% 1-year survival as compared with the 68% survival for those with a right atrial pressure < 12 mm Hg. HRS was the next strongest predictor of survival. The 66% survival in group I (HRS = 0) and the 69% survival in group II (HRS = 1 to 3) were significantly (p < 0.03) higher than the 41% survival in group III (HRS = 4 to 6) at 1 year after listing. Differences in survival for the HRS groups could not be explained by left ventricular ejection fraction, left ventricular end-diastolic diameter or status at listing.(ABSTRACT TRUNCATED AT 250 WORDS)