Abstract 17760: Predictors of Mortality in Patients With Prior Orthotopic Cardiac Transplantation Undergoing Dobutamine Stress Echocardiography
Background: Mortality remains high following orthotopic heart transplantation (OHT), despite improvement in therapies. Cardiac allograft vasculopathy (CAV) is a cause of death beyond first year after OHT. Dobutamine stress echocardiography (DSE) is performed to evaluate for CAV. We sought to determine predictors of long-term mortality in OHT patients undergoing DSE.
Methods: We studied 391 patients (62±11 years, 75% male) with a prior history of OHT (performed between 1984-2011, mean duration 7.2±3.3 years), who underwent DSE between 1998-2012. Patient with submaximal heart rate response & prior revascularization (following OHT) were excluded. Baseline clinical, demographic parameters including all-cause mortality were collected. Conventional echocardiographic & DSE data were recorded. Hard events included death or re-transplantation.
Results: Mean left ventricular ejection fraction & end-systolic dimension were 57±6% and 2.8±0.6 cm, respectively. At rest, 3% patients had ≥2+ mitral regurgitation, 29% ≥2+ tricuspid regurgitation & 10% right ventricular dysfunction, with a mean right ventricular systolic pressure of 31±8 mm Hg. On DSE, predicted maximal heart rate was 89±5%, while only 19 patients (5%) were positive for ischemia. Mean glomerular filtration rate was 62±32 mL/min. There were 36% diabetics, 82% hypertensives & 5% dyslipidemics. 23% patients had cytomegalovirus infection, 19% with persistent grade ≥ 2 cellular rejection, 3% with antibody mediated infection & 9% had non-dermatologic cancer during follow-up. During a mean follow-up of 4.7 years (interquartile range 2-8 years), 109 patients (28%) had an event (4 had a re-transplant). Results of Cox survival analysis are shown in Figure 1. Ischemia on DSE did not independently predict events.
Conclusions: In OHT patients undergoing follow-up DSE, only GFR & appearance of non-dermatologic cancer predicted long-term events. No DSE parameters independently predicted long-term outcomes.
- © 2013 by American Heart Association, Inc.