Transplant candidates with severe left ventricular dysfunction managed with medical treatment: Characteristics and survival

Abstract

In the current treatment era, prognosis is favorable in a definable group of transplant candidates despite severe left ventricular dysfunction. This patient group can be identified after intensive medical therapy by stable symptoms, a relatively high maximal oxygen uptake at peak exercise and a preserved cardiac output.

Pulmonary hypertension in left heart disease

“…The degree of PH in patients with HFPEF in this study was often severe, and systolic Ppa above the study median (48 mmHg) was associated with significantly shorter survival rates, confirming findings of earlier studies demonstrating that PH is an important determinant of mortality and morbidity in patients with heart failure [28,31,39]. Ppa, systolic Ppa and diastolic Ppa have also been shown to be predictive of a need for heart transplantation in patients with severe LV dysfunction [40]. In patients with valvular disease, PH increases the likelihood of poor surgical outcome, although surgery is associated with better outcome overall compared with conservative management [8].…”

Effect of Heart Failure Program on Cardiovascular Drug Utilization and Dosage in Patients with Chronic Heart Failure

“…Recently published data provided evidence for the superiority and cost effectiveness of specialized heart failure care.24, 46-47, [49][50][51] This study examined the effect of specialized care on the pharmacologic therapy of patients with heart failure. It showed that care at a specialized heart failure clinic was associated with increase in the utilization of all known beneficial cardiovascular drugs, significant increase in the dose of ACE inhibitors, and intensification of diuretic regimen.…”

“…The heart failure hospitalization rate for this group of patients was low, and the 1 -year survival was 90%, both comparable with data reported for similar populations followed at other specialized heart failure programs.24. 503 51 This improvement in cardiovascular pharmacologic therapy may be one of the major reasons accounting for the better clinical outcomes in specialized programs. It involves higher utilization and doses of ACE inhibitors, more intense diuresis, and higher utilization of ARBS, spironolactone, beta blockers, amiodarone, and the combination of hydralazine and nitrates.…”

Heart Transplantation: A Thirty-Year Perspective

“…While the number of heart failure patients continually increases, the treatment of heart failure continues to improve. Some patients with severe left ventricular dysfunction remain symptom-free, and some studies indicate that for correctly selected patients, medical management can achieve similar symptomatic and survival outcomes as heart transplantation (26,27). Therefore, as a general rule, evaluation for potential heart transplantation should be instituted only if a contraindication-free patient continues to suffer severe cardiac disability despite optimal medical management.…”