Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

Abstract

Aims.To determine the effect of pre-existing pulmonary hypertension (PHT) on early hemodynamics, morbidity and mortality after heart transplantation (HTx). Methods. Data were prospectively collected from 149 patients, who underwent HTx between January 2000 and December 2007. The subjects were divided into 3 groups: Group A (n=84) without PTH, group B (n=50) with mild to moderate PTH and group C (n=15) with severe PTH. We studied hemodynamic profile, tricuspid valve regurgitation (TR), incidence of acute cellular rejections (AR), infections, duration of hospitalization, 30-day mortality and a longterm survival. Results. Baseline characteristics were similar in all groups. Using vasodilator treatment PVR was successfully brought down to normal range 2.5 ± 0.6 Wood' units (WU) on the day 1 following the surgery in all groups. Over 80% of patients were treated in Group C, 32% in Group A and 46% in Group B. There was no significant difference in the severity of TR among the 3 groups early after HTx (severe TR was observed in 46%, 54%, 33%, respectively). There was no significant difference in incidence of AR (G ≥ 2 Banff classification) (23%, 23%, 33%, respectively), infections (28%, 32%, 33%, respectively) or duration of hospitalization (30, 30, 28 days, respectively). There was no correlation between pre-transplant PHT and 30-day mortality or a long-term survival. Conclusions. In our cohort, PHT dropped very quickly after HTx, and was not associated with acute right heart failure following the surgery. Reversible PTH does not have a negative impact on short-or long-term survival after HTx.

Urinary Peptidomic Biomarker for Personalized Prevention and Treatment of Diastolic Left Ventricular Dysfunction

“…For a 1‐SD increment in HF1, the adjusted odds ratio was 1.37 (95% CI, 1.07 to 1.76; p = 0.013). The integrated discrimination improvement (+1.14%) and the net reclassification improvement (+31.7%) of the optimized HF1 threshold (–0.350) in discriminating normal from abnormal diastolic LV function at follow‐up over and beyond other risk factors were significant ( p ≤ 0.024) …”

“…The adjusted odds ratio for having an elevated right heart pressure (mRAP, mPAP, or mPCWP, ≥10, ≥24, or ≥17 mm Hg, respectively) was 1.56 for HF2 ( p ≤ 0.005). Adding HF2 per optimized threshold (≥0.15) increased both the integrated discrimination improvement (+1.92%; p = 0.023) and the net reclassification improvement (+30.3%; p = 0.010). The association of mRAP and mPAP with the urinary classifier HF2 is physiologically plausible, because fibrosis is a hallmark of graft malfunction.…”

Biomarkers to Assess Right Heart Pressures in Recipients of a Heart Transplant: A Proof-of-Concept Study

“… 23 Right heart pressures change significantly in the first months after HTx as the allograft and the vasculature of the host adjust to the posttransplant condition. 24 Right heart catheterization after this adaptive phase usually reveals smaller pressure changes unless rejection occurs. In our current study, in all the 298 HTx patients, right heart catheterization was performed within 6 months of urine sampling during this stable phase.…”