Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?
Interactive Cardiovascular and Thoracic Surgery
The natural history of the LV systolic function (LV-SF) and functional capacity of survivors of heart transplantation (Htx) has not been defined. Some investigators suggest that SF may be different in recipients with different pre-transplant aetiologies: ischaemic or dilated, idiopathic disease. Routine transthoracic echocardiograms (TTE) were performed during a 1-year follow-up in 48 Htx recipients (total 864 examinations; mean 18ypatient). Patients were divided into two groups based on
... ups based on pre-transplant diagnosis: ischaemic (CAD-CMP: ns13, age 54"1.7 years, 23% females) and idiopathic dilated cardiomyopathy (ID-CMP: ns35, age 51"2.3 years, 26% females). Patients with valvular and toxic aetiology were excluded. All patients underwent left ventriculography (VENT) 12-15 months after Htx. The majority of 1-year survivors of Htx maintained normal LV-SF: mean LVEF 65"4% by echocardiography and 68"3% by ventriculography, but in the ID-CMP group LVEF was significantly higher: 67"4% vs. 62"4% (TTE) and 77"4% vs. 60"4% (VENT), without significant differences in functional capacity (NYHA). 82.9% of ID-CMP patients had LVEF )65% vs. 39% in CAD-CMP. The incidence of acute cellular rejection, freedom from cardiac vasculopathy, renal failure, diabetes, hypertension and pre-transplant alloantibody level was similar. Our study shows a strong correlation between pre-transplant heart disease and the systolic function of the cardiac allograft at 1-year follow-up.