Biomedical papers, 2014 (vol. 158), issue 2

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(2):295-302 | 10.5507/bp.2013.095

High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Jaroslav Meluzina,b#, Petr Hudea,b#, Pavel Leinvebera, Jan Krejcia,b, Lenka Spinarovaa,b, Helena Bedanovac, Helena Podrouzkovaa, Radka Stepanovad, Petr Nemecc
a Department of Cardiovascular Diseases, ICRC, St. Anne's Hospital in Brno, Czech Republic
b Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno
c Centre of Cardiovascular and Transplant Surgery, ICRC, St. Anne's Hospital in Brno
d ICRC, St. Anne's Hospital in Brno

Aim: Post-heart transplant patients are at increased risk of diastolic dysfunction. The aim of this study was to assess the prevalence of isolated only exercise-induced heart failure with normal ejection fraction (HFNEF) in heart transplant recipients.

Methods and Results: To determine pulmonary capillary wedge pressure (PCWP) at rest and during exercise, 81 patients after orthotopic heart transplantation with normal left ventricular ejection fraction (LVEF) underwent exercise right heart catheterization with simultaneous exercise echocardiography. Based on PCWP values, the patients were divided into three groups. Twenty-one patients had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise < 25 mmHg, prevalence 26%). Forty-seven subjects were found to have only exercise-induced HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise ≥ 25 mmHg, prevalence 58%). Thirteen patients had HFNEF already at rest (PCWP ≥ 15 mmHg at rest, prevalence 16%). Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF.

Conclusions: In heart transplant recipients with normal LVEF, there is a high prevalence of exercise-induced HFNEF. LV mass index adjusted for allograft age is predictive of exercise-induced HFNEF.

Keywords: heart transplantation, heart failure, pulmonary capillary wedge pressure, diastolic dysfunction

Received: August 30, 2013; Accepted: December 13, 2013; Prepublished online: January 27, 2014; Published: June 23, 2014


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