Diastolic function changes of the left and right ventricle after heart transplantation

    Authors

    Keywords

    heart transplantation, diastolic function, donor age, pulmonary hypertension, acute right ventricular failure

    DOI

    https://doi.org/10.15836/ccar2019.96

    Full Text

    Background: A new hemodynamic environment is set up after heart transplantation (HTx). ( 1 , 2 ) Our aim was to assess changes in diastolic function of the left (LV) and right (RV) ventricle in HTx patients (Pts) during the 1 st year and the influence of donor age, graft ischemic time (GIT) and acute right ventricular failure (ARVF). Patients and Methods: In 55 “healthy” HTx Pts echo was performed 1- and 12 months after HTx. Data on mitral valve (MV) E- (Ew) and A-wave velocity (Aw), MV and tricuspid (TV) E/A ratio, MV and TV E’ and A’ by tissue Doppler, septal E/E’, pulmonary vein diastolic velocity (PVd), systolic pulmonary pressure (sPAP), left atrial indexed volume (LAVI), right atrial pressure (RAP) were collected. Results: Ew significantly decreases during the 1 st year (0.80 vs. 0.73 m/s; p=0.036) as well as E/E’ (11.5 vs. 9.1; p=0.009), PVd (0.67 vs. 0.55 m/s; p<0.001) and sPAP (33 vs. 26 mmHg; p<0.001) without concomitant significant change in Aw (p=0.855) and LAVI (p=0.060). TV E/A, TV-E’and TV-A’ show no significant change. Pts with significant pulmonary hypertension (PAH) in the 1 st month have higher Ew (0.90 vs. 0.75 m/; p=0.021), E/A (2.2 vs. 1.7; p=0.034) and E/E’ (14 vs. 10; p=0.047) but after 1-year only elevated mitral E/A (2.2 vs. 1.6; p=0.014), without change in LAVI (p=0.095). Higher donor age (> mean of 41 years) caused initially lower MV-E’ (r=-0.390, p=0.010) and higher sPAP (r=0.285; p=0.045). GIT had no influence on diastolic parameters. ARVF significantly correlated with lower TV-A’ acutely and after 1 year (ARVF 5 vs. no-ARVF 8 cm/s; r=-0.600, p= 0.011) and higher RAP (r=0.414, p=0.003). Conclusion: During the 1 st postransplant year there is improvement in LA diastolic function with better early passive LV filling and reduction in PAH, without change in active filling phase or LA volume. In Pts with significant PAH mean E/E’ ratio within 1 st month was 14, but after a year in Pts with persistent PAH it declines to only 10, preserving the higher E/A ratio. Higher donor age could impair the early LV ventricular filling with a trend toward more PAH but MV-E’ improves with time. ARVF reduces active RV filling (TV-A’) throughout the 1st year. GIT does not have influence on diastole.

    Cardiologia Croatica
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    Diastolic function changes of the left and right ventricle after heart transplantation

    Extended Abstract
    Issue3-4
    Published
    Pages96
    PDF via DOIhttps://doi.org/10.15836/ccar2019.96
    heart transplantation
    diastolic function
    donor age
    pulmonary hypertension
    acute right ventricular failure

    Authors

    Jana Ljubas Maček*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marija ManceORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Nina JakušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Daniel LovrićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora FabijanovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Background: A new hemodynamic environment is set up after heart transplantation (HTx). ( 1 , 2 ) Our aim was to assess changes in diastolic function of the left (LV) and right (RV) ventricle in HTx patients (Pts) during the 1 st year and the influence of donor age, graft ischemic time (GIT) and acute right ventricular failure (ARVF). Patients and Methods: In 55 “healthy” HTx Pts echo was performed 1- and 12 months after HTx. Data on mitral valve (MV) E- (Ew) and A-wave velocity (Aw), MV and tricuspid (TV) E/A ratio, MV and TV E’ and A’ by tissue Doppler, septal E/E’, pulmonary vein diastolic velocity (PVd), systolic pulmonary pressure (sPAP), left atrial indexed volume (LAVI), right atrial pressure (RAP) were collected. Results: Ew significantly decreases during the 1 st year (0.80 vs. 0.73 m/s; p=0.036) as well as E/E’ (11.5 vs. 9.1; p=0.009), PVd (0.67 vs. 0.55 m/s; p<0.001) and sPAP (33 vs. 26 mmHg; p<0.001) without concomitant significant change in Aw (p=0.855) and LAVI (p=0.060). TV E/A, TV-E’and TV-A’ show no significant change. Pts with significant pulmonary hypertension (PAH) in the 1 st month have higher Ew (0.90 vs. 0.75 m/; p=0.021), E/A (2.2 vs. 1.7; p=0.034) and E/E’ (14 vs. 10; p=0.047) but after 1-year only elevated mitral E/A (2.2 vs. 1.6; p=0.014), without change in LAVI (p=0.095). Higher donor age (> mean of 41 years) caused initially lower MV-E’ (r=-0.390, p=0.010) and higher sPAP (r=0.285; p=0.045). GIT had no influence on diastolic parameters. ARVF significantly correlated with lower TV-A’ acutely and after 1 year (ARVF 5 vs. no-ARVF 8 cm/s; r=-0.600, p= 0.011) and higher RAP (r=0.414, p=0.003). Conclusion: During the 1 st postransplant year there is improvement in LA diastolic function with better early passive LV filling and reduction in PAH, without change in active filling phase or LA volume. In Pts with significant PAH mean E/E’ ratio within 1 st month was 14, but after a year in Pts with persistent PAH it declines to only 10, preserving the higher E/A ratio. Higher donor age could impair the early LV ventricular filling with a trend toward more PAH but MV-E’ improves with time. ARVF reduces active RV filling (TV-A’) throughout the 1st year. GIT does not have influence on diastole.