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Early Doppler echocardiographic dysfunction is associated with an increased mortality after orthotopic cardiac
H J Ross1, L Gullestad, S A Hunt
1Division of Cardiovascular Medicine, Stanford University School of Medicine, Calif 94305-5246, USA.
Insights
Early diastolic dysfunction detected by Doppler echocardiography within six months of heart transplantation is linked to worse long-term survival. This finding highlights the importance of monitoring diastolic function post-transplant for predicting patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Diagnostic Imaging
Background:
- Doppler echocardiography (DE) diastolic dysfunction is linked to rejection after orthotopic cardiac transplantation (Tx).
- The impact of early diastolic dysfunction on long-term outcomes after heart Tx remains unclear.
Purpose of the Study:
- To investigate the correlation between early DE diastolic dysfunction and patient outcomes following heart Tx.
Main Methods:
- Analysis of 83 heart transplant recipients with at least 4 DE studies in the first 6 months post-Tx.
- Diastolic function assessed using isovolumic relaxation time (IVRT), pressure half-time (PHT), and peak early mitral inflow velocity (M1).
- Diastolic dysfunction defined by specific percentage changes in DE parameters; a mean dysfunction score (MDS) calculated to compare groups.
Main Results:
- Patients with higher early diastolic dysfunction scores (MDS > mean) exhibited significantly reduced actuarial survival compared to those with lower scores (MDS < mean) (P < .05).
- The average survival time was 384 days for the high dysfunction group versus 786 days for the low dysfunction group.
- No significant differences were observed in rejection episodes, transplant coronary artery disease (TxCAD), or other clinical factors between the groups.
Conclusions:
- Early diastolic dysfunction, identified within 6 months post-heart transplantation, is associated with increased late mortality.
Background:
Doppler echocardiographic (DE) diastolic dysfunction has been correlated with rejection after orthotopic cardiac transplantation (Tx). However, the relationship of early diastolic dysfunction to late outcome is unknown. The purpose of this study was to assess the correlation between early DE diastolic dysfunction and outcome after heart Tx.
Methods And Results:
Of 133 patients undergoing heart Tx between October 1990 and April 1994, 83 were identified with > or = 4 routine DE performed during the first 6 months. Assessment of diastolic function included measurement of isovolumic relaxation time (IVRT), pressure half-time (PHT), and peak early mitral inflow velocity (M1). Diastolic dysfunction was defined as a decrease of 15% from baseline (IVRT and PHT) or an increase of 20% (M1). A mean dysfunction score (MDS) was calculated for each patient (number of episodes of dysfunction by Doppler total number of echocardiograms performed). The population diastole MDS was determined and two groups established (group 1, MDS < mean; group 2, MDS > mean). Actuarial survival, rejection, and transplant coronary artery disease (TxCAD) were compared between groups. Actuarial survival was significantly reduced in patients with greater early diastolic dysfunction (P < .05). There were 17 deaths overall: 5 in group 1 (mean, 786 days) and 12 in group 2 (mean, 384 days). There were no significant differences in treated rejection episodes, actuarial freedom from rejection or TxCAD, immunosuppression, sex, donor age, donor ischemic time, or cytomegalovirus between the two groups.
Conclusions:
Diastolic dysfunction within 6 months of transplant was associated with an increased late mortality.