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Long-term myocardial function after heart transplantation

W von Scheidt1, U Ziegler, B M Kemkes

  • 1Department of Internal Medicine I, Klinikum Grosshadern, Munich University, Germany.

The Thoracic and Cardiovascular Surgeon
|June 1, 1993
PubMed
Summary
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Long-term heart transplant recipients develop arterial hypertension due to increased systemic vascular resistance, but myocardial function remains stable. Allograft coronary angiopathy, not myocardial function, is the primary long-term cardiac concern post-transplant.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Immunosuppression

Background:

  • Increasing heart transplantations and improved survival necessitate understanding long-term hemodynamic profiles.
  • Cyclosporine A is a common immunosuppressive agent in heart recipients.

Purpose of the Study:

  • To characterize the long-term hemodynamic profile of transplanted hearts.
  • To identify critical cardiac issues in heart transplant survivors.

Main Methods:

  • 222 cardiac catheterizations in 71 heart recipients over 7 years.
  • Hemodynamic evaluation including pressure-volume loops.
  • Assessment of allograft coronary angiopathy and rejection episodes.

Main Results:

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  • Non-progressive arterial hypertension developed, linked to increased systemic vascular resistance.
  • Left-ventricular chamber stiffness mildly increased; systolic myocardial function remained normal.
  • Allograft coronary angiopathy prevalence rose significantly over time (13% at 1 year to 54% at 5 years).
  • Myocardial function was unaffected by coronary angiopathy or rejection history.
  • No evidence of dilated or restrictive cardiomyopathy was observed.

    • Conclusions:

    • Heart transplant recipients experience stable myocardial function but develop hypertension.
    • Allograft coronary angiopathy is the most critical long-term cardiac complication, surpassing myocardial dysfunction.
    • Long-term management should focus on mitigating coronary angiopathy risks.