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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.
Insights
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:
- 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.
Abstract:
With an increasing number of heart transplantations and an improved survival rate a characterization of the long-term hemodynamic profile of the transplanted heart is necessary. 222 cardiac catheterizations were performed in 71 heart recipients under cyclosporine A immunosuppression during a 7-year follow-up after transplantation. Hemodynamic evaluation revealed a non-progressive arterial hypertension due to an increased systemic vascular resistance, leading to a mild increase of left-ventricular chamber stiffness. Parameters of systolic myocardial function were found to be normal and did not deteriorate during the 7 year period. The prevalence of allograft coronary angiopathy increased from 13% one year to 54% five years after transplantation. Myocardial function was neither adversely influenced by the presence of coronary angiopathy nor by the number or severity of former rejection episodes. Unchanged annual pressure-volume loops excluded the development of a dilated or restrictive posttransplantation cardiomyopathy. Thus, not the myocardial function, but the coronary angiopathy represents the most critical cardiac long-term problem after transplantation.