Abstract 16975: Dynamics of Left Ventricular Function After Lung Transplantation; A Serial Echocardiographic Investigation
Background: Echocardiographic measures of right ventricular (RV) function have been reported to be associated with outcome in patients undergoing lung transplantation (LTx). However, the changes of left ventricular (LV) function before and after LTx are less well defined.
Methods: We retrospectively reviewed echocardiograms obtained from 67 patients undergoing LTx (36 male; mean age 51.9 years; 54 double lung) recorded at the time of evaluation and one-year post transplant.
Results: Regardless of the primary lung disease, RV systolic and diastolic echo parameters improved or were preserved after transplant in all LTx recipients (RV fractional area change, 37.9±4.8 to 42.0±3.1%, RV longitudinal strain, -14.8±2.7 to -18.3±-2.9%, E/E’ 9.1±-2.8 to 8.0±3.3; all p5% decrease in LV ejection fraction (LVEF) (60.1+/-5.9 to 50.5+/-6.3, p<0.001; Group LVD), and LV strain and LV E/E’ also deteriorated significantly (-23.6±4.4 to -17.4±3.6%, 10.4±2.4 to 12.2±2.2, respectively, both p<0.01). The remaining 39 patients (58%) showed no change or improvement of these parameters (Group LVP). Pre-transplant clinical characteristics and exercise capacity were not different between LVD and LVP groups; however, pre-transplant LVEF and LV E/E’ were higher (60.1±5.9 vs. 56.0±5.4%, 10.2±2.4 vs. 8.9±.6, respectively, both p<0.05), left atrial diameter tended to be larger (38.2±3.5 vs. 35.3±7.4, p=0.059) and more patients suffered from post-capillary pulmonary hypertension (PH), defined as mean pulmonary artery pressure ≥ 25 mmHg and left ventricular filling pressure ≥ 15 mmHg, in the LVD group (75% vs. 33%, p<0.001). Furthermore, 16 patients with post-capillary PH in group LVD (76%) had passive PH defined as transpulmonary gradient ≤ 12 mmHg. Multivariate analysis revealed LV E/E’ and post-capillary PH were associated with post-transplant LV deterioration (OR 1.2, 1.8, respectively, both p<0.05).
Conclusions: While RV function improves or is preserved after LTx, LV systolic and diastolic function may deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant and post-capillary PH, especially of the passive type, appear to increase the risk of LV function deterioration after LTx.
- © 2013 by American Heart Association, Inc.