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Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?

Program of Heart Transplantation, Centre of Cardiothoracic Surgery, University Hospital, Coimbra, Portugal

*Corresponding author. Centro de Cirurgia Cardiotorácica, Hospitais da Universidade, 3000-075 Coimbra, Portugal. Tel.: +351-239400418; fax: +351-239829674.

E-mail address: antunes.cct.huc{at}sapo.pt (M.J. Antunes).

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 18/patient). Patients were divided into two groups based on pre-transplant diagnosis: ischaemic (CAD-CMP: n=13, age 54±1.7 years, 23% females) and idiopathic dilated cardiomyopathy (ID-CMP: n=35, 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.

Key Words: Heart transplantation; LV function; Echocardiography