Hemodynamic Characteristics Including Pulmonary Hypertension at Rest and During Exercise Before and After Heart Transplantation

Abstract

BackgroundLittle is known about the hemodynamic response to exercise in heart failure patients at various ages before and after heart transplantation (HT). This information is important because postoperative hemodynamics may be a predictor of survival. To investigate the hemodynamic response to HT and exercise, we grouped our patients based on preoperative age and examined their hemodynamics at rest and during exercise before and after HT.Methods and ResultsNinety-four patients were evaluated at rest prior to HT with right heart catheterization at our laboratory. Of these patients, 32 were evaluated during slight supine exercise before and 1 year after HT. Postoperative evaluations were performed at rest 1 week after HT and at rest and during exercise at 4 weeks, 3 months, 6 months, and 1 year after HT. The exercise patients were divided into 2 groups based on preoperative age of ≤50 or >50 years. There were no age-dependent differences in the preoperative hemodynamic exercise responses. Hemodynamics markedly improved at rest and during exercise at 1 and 4 weeks, respectively, after HT; however, pulmonary and, in particular, ventricular filling pressures remained high during exercise at 1 year after HT, resulting in normalized pulmonary vascular resistance response but deranged total pulmonary vascular resistance response.ConclusionsOur findings suggest that, (1) in patients with heart failure age ≤50 or >50 years may not affect the hemodynamic response to exercise to the same extent as in healthy persons, and (2) total pulmonary vascular resistance may be more adequate than pulmonary vascular resistance for evaluating the exercise response after HT.

Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

“…23,26,27 The results of the present study are in line with previous studies as we found resting LV-filling and RV-filling pressures within the normal range in most patients. Studies of invasive haemodynamics demonstrate that resting LV and RV filling pressures tend to normalize in most HTx patients during the first months after surgery, whereas pulmonary arterial compliance remains reduced.…”

“…Studies of invasive haemodynamics demonstrate that resting LV and RV filling pressures tend to normalize in most HTx patients during the first months after surgery, whereas pulmonary arterial compliance remains reduced. 23,26,27 The results of the present study are in line with previous studies as we found resting LV-filling and RV-filling pressures within the normal range in most patients. However, the haemodynamic response to exercise is clearly abnormal in HTx patients.…”

Prolargin and matrix metalloproteinase‐2 in heart failure after heart transplantation and their association with haemodynamics

“…41 However, such investigation needs a larger population and an early post-transplant follow-up, as reduction in PVR is most abundant within the first month 42 and is maintained throughout the first year after HT. 13 Additionally, MMP-2 may be a marker related to HF aggravation and passive pulmonary congestion, as indicated by the correlation of ΔMMP-2 with ΔNT-proBNP, ΔMRAP respectively ΔPAWP and ΔmPAP (Figure 4). Whether the cardiopulmonary expression of MMP-2 is a main source of circulating MMP-2 levels in end-stage HF and/or PH-LHD remains to be elucidated.…”

“…12 In a previous study, we characterized the haemodynamics of patients at rest and exercise, before and after heart transplantation (HT), and found that post-operative resting haemodynamics improved and were maintained throughout the first year after HT. 13 The aim of the present study was to additionally investigate the plasma levels of ECM proteins in relation to improved haemodynamics before and 1 year after HT, to identify target ECM proteins that may be linked to end-stage HF and PH, resolved in response to HT.…”

Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation

“…Cardiac transplantation (CTx) improves survival, relieves symptoms and normalizes resting hemodynamics in patients with end‐stage heart failure . However long‐term survival remains compromised and functional capacity rarely exceeds the 60%‐70% VO 2 peak of the age‐predicted values in these patients . Proposed mechanisms for such limited aerobic reserve include chronotropic incompetence reduced stroke volume as well as some peripheral mechanisms such as endothelial dysfunction and steroids‐induced myopathy .…”