Left and Right Ventricular Functional Dynamics Determined by Echocardiograms Before and After Lung Transplantation

Abstract

Impaired cardiac function is considered a contraindication for lung transplantation (LT). Since right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2D speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV-echo parameters improved in all patients following LT (RV fractional area change: 36.7±5.6 to 41.5±2.7%, RV strain: −15.5±2.9 to −18.0±2.1%, RV E/E’: 8.4±1.8 to 7.7±1.8; all p<0.05). Overall, the LV ejection fraction (LVEF) did not change (58.7±6.0 to 57.5±9.7%, p=0.385); however, 20 patients (30%) showed more than a 10% decrease in LVEF after LT (61.5±6.1 to 47.3±4.2%, p<0.001), and an increase in LV E/E’ (11.8±1.8 to 12.9±2.2, p=0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E’ was associated with decrease in LVEF after LT [odds ratio (OR) 1.381, 95%CI (confidential interval) 1.010–1.947, p=0.043]. Furthermore, patients with strain data showed lower pre-LT LV strain was independently associated with LVEF decrease after LT (OR 1.293, 95%CI 1.088–1.614, p=0.002). While RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.

Donor and recipient age matching in lung transplantation: A retrospective study

“…Furthermore, a retrospective study reported that pre-transplant diabetes mellitus could increase the risk of cancer after LTx, and cancer is a major source of morbidity and mortality in patients with solid organ transplantations [ 23 ]. To our knowledge, diabetes also increases the morbidity of cardiovascular diseases, which are thought to increase the mortality of patients receiving LTx [ [24] , [25] , [26] ].…”