Advertisement

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

      Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because 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 2-dimensional 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 after 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 left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%, p = 0.385); however, 20 patients (30%) showed >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 1.381, 95% confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95% confidence interval 1.088 to 1.614, p = 0.002). Although 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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Christie J.D.
        • Edwards L.B.
        • Kucheryavaya A.Y.
        • Aurora P.
        • Dobbels F.
        • Kirk R.
        • Rahmel A.O.
        • Stehlik J.
        • Hertz M.I.
        The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report—2010.
        J Heart Lung Transplant. 2010; 29: 1104-1118
        • Orens J.B.
        • Estenne M.
        • Arcasoy S.
        • Conte J.V.
        • Corris P.
        • Egan J.J.
        • Egan T.
        • Keshavjee S.
        • Knoop C.
        • Kotloff R.
        • Martinez F.J.
        • Nathan S.
        • Palmer S.
        • Patterson A.
        • Singer L.
        • Snell G.
        • Studer S.
        • Vachiery J.L.
        • Glanville A.R.
        • Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation
        International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.
        J Heart Lung Transplant. 2006; 25: 745-755
        • Plantier L.
        • Skhiri N.
        • Biondi G.
        • Jebrak G.
        • Himbert D.
        • Castier Y.
        • Lesèche G.
        • Mal H.
        • Thabut G.
        • Fournier M.
        Impact of previous cardiovascular disease on the outcome of lung transplantation.
        J Heart Lung Transplant. 2010; 29: 1270-1276
        • van de Veerdonk M.C.
        • Kind T.
        • Marcus J.T.
        • Mauritz G.J.
        • Heymans M.W.
        • Bogaard H.J.
        • Boonstra A.
        • Marques K.M.
        • Westerhof N.
        • Vonk-Noordegraaf A.
        Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy.
        J Am Coll Cardiol. 2011; 58: 2511-2519
        • Chatila W.M.
        • Furukawa S.
        • Gaughan J.P.
        • Criner G.J.
        Respiratory failure after lung transplantation.
        Chest. 2003; 1231: 165-173
        • Saggar R.
        • Lynch J.P.
        • Belperio J.A.
        • Weigt S.S.
        • Derhovanessian A.
        • Gupta S.
        • Saggar R.
        Pulmonary arterial hypertension and lung transplantation.
        Semin Respir Crit Care Med. 2010; 312: 147-160
        • Zalunardo M.P.
        • Thalmann C.
        • Seifert B.
        • D'Cunja J.
        • Weder W.
        • Boehler A.
        • Spahn D.R.
        Impact of preoperative right-ventricular function and platelet transfusion on outcome after lung transplantation.
        Eur J Cardiothorac Surg. 2011; 39: 538-542
        • Olland A.
        • Falcoz P.E.
        • Canuet M.
        • Massard G.
        Should we perform bilateral-lung or heart–lung transplantation for patients with pulmonary hypertension?.
        Interact Cardiovasc Thorac Surg. 2013; 17: 166-170
        • Pielsticker E.
        • Martinez F.
        • Rubenfire M.
        Lung and heart-lung transplant practice patterns in pulmonary hypertension centers.
        J Heart Lung Transplant. 2001; 20: 1297-1304
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        • Chamber Quantification Writing Group
        • American Society of Echocardiography's Guidelines and Standards Committee
        • European Association of Echocardiography
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Rudski L.G.
        • Lai W.W.
        • Afilalo J.
        • Hua L.
        • Handschumacher M.D.
        • Chandrasekaran K.
        • Solomon S.D.
        • Louie E.K.
        • Schiller N.B.
        Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.
        J Am Soc Echocardiogr. 2010; 23: 685-713
        • Ommen S.R.
        • Nishimura R.A.
        • Appleton C.P.
        • Miller F.A.
        • Oh J.K.
        • Redfield M.M.
        • Tajik A.J.
        Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study.
        Circulation. 2000; 102: 1788-1794
        • Temporelli P.L.
        • Scapellato F.
        • Eleuteri E.
        • Imparato A.
        • Giannuzzi P.
        Doppler echocardiography in advanced systolic heart failure: a noninvasive alternative to Swan-Ganz catheter.
        Circ Heart Fail. 2010; 3: 387-394
        • Maurer M.
        • Burkhoff D.
        • Maybaum S.
        • Franco V.
        • Vittorio T.J.
        • Williams P.
        • White L.
        • Kamalakkannan G.
        • Myers J.
        • Mancini D.M.
        A multicenter study of noninvasive cardiac output during symptom limited exercise.
        J Card Fail. 2009; 15: 689-699
        • Aaronson K.D.
        • Mancini D.M.
        Is percentage of predicted maximal exercise oxygen consumption a better predictor of survival than peak exercise oxygen consumption for patients with severe heart failure?.
        J Heart Lung Transplant. 1995; 14: 981-989
        • Galiè N.
        • Hoeper M.M.
        • Humbert M.
        • Torbicki A.
        • Vachiery J.L.
        • Barbera J.A.
        • Beghetti M.
        • Corris P.
        • Gaine S.
        • Gibbs J.S.
        • Gomez-Sanchez M.A.
        • Jondeau G.
        • Klepetko W.
        • Opitz C.
        • Peacock A.
        • Rubin L.
        • Zellweger M.
        • Simonneau G.
        • ESC Committee for Practice Guidelines (CPG)
        Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT).
        Eur Heart J. 2009; 30: 2493-2537
        • Badesch D.B.
        • Champion H.C.
        • Sanchez M.A.
        • Hoeper M.M.
        • Loyd J.E.
        • Manes A.
        • McGoon M.
        • Naeije R.
        • Olschewski H.
        • Oudiz R.J.
        • Torbicki A.
        Diagnosis and assessment of pulmonary arterial hypertension.
        J Am Coll Cardiol. 2009; 54: S55-S66
        • Simonneau G.
        • Robbins I.M.
        • Beghetti M.
        • Channick R.N.
        • Delcroix M.
        • Denton C.P.
        • Elliott C.G.
        • Gaine S.P.
        • Gladwin M.T.
        • Jing Z.C.
        • Krowka M.J.
        • Langleben D.
        • Nakanishi N.
        • Souza R.
        Updated clinical classification of pulmonary hypertension.
        J Am Coll Cardiol. 2009; 54: S43-S54
        • de Perrot M.
        • Granton J.T.
        • McRae K.
        • Pierre A.F.
        • Singer L.G.
        • Waddell T.K.
        • Keshavjee S.
        Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: a 14-year single-center experience.
        J Thorac Cardiovasc Surg. 2012; 143: 910-918
        • Gallego-Delgado J.
        • Connolly S.B.
        • Lázaro A.
        • Sadlier D.
        • Kieran N.E.
        • Sugrue D.D.
        • Doran P.
        • Brady H.R.
        • Osende J.
        • Egido J.
        Transcriptome of hypertension-induced left ventricular hypertrophy and its regression by antihypertensive therapies.
        Hypertens Res. 2009; 32: 347-357
        • Gosse P.
        Left ventricular hypertrophy—the problem and possible solutions.
        J Int Med Res. 2005; 33: 3A-11A
        • Houmsse M.
        • Tyler J.
        • Kalbfleisch S.
        Supraventricular tachycardia causing heart failure.
        Curr Opin Cardiol. 2011; 26: 261-269
        • Huffman C.
        • Wagman G.
        • Fudim M.
        • Zolty R.
        • Vittorio T.
        Reversible cardiomyopathies—a review.
        Transplant Proc. 2010; 42: 3673-3678
        • Ellis E.R.
        • Josephson M.E.
        Heart failure and tachycardia-induced cardiomyopathy.
        Curr Heart Fail Rep. 2013; 10: 296-306
        • Solomon S.D.
        • Verma A.
        • Desai A.
        • Hassanein A.
        • Izzo J.
        • Oparil S.
        • Lacourciere Y.
        • Lee J.
        • Seifu Y.
        • Hilkert R.J.
        • Rocha R.
        • Pitt B.
        • Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction Investigators
        Effect of intensive versus standard blood pressure lowering on diastolic function in patients with uncontrolled hypertension and diastolic dysfunction.
        Hypertension. 2010; 55: 241-248
        • Melenovsky V.
        • Borlaug B.A.
        • Rosen B.
        • Hay I.
        • Ferruci L.
        • Morell C.H.
        • Lakatta E.G.
        • Najjar S.S.
        • Kass D.A.
        Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction.
        J Am Coll Cardiol. 2007; 49: 198-207
        • Kitahori K.
        • He H.
        • Kawata M.
        • Cowan D.B.
        • Friehs I.
        • Del Nido P.J.
        • McGowan Jr., F.X.
        Development of left ventricular diastolic dysfunction with preservation of ejection fraction during progression of infant right ventricular hypertrophy.
        Circ Heart Fail. 2009; 2: 599-607
        • Kato T.S.
        • Noda A.
        • Izawa H.
        • Yamada A.
        • Obata K.
        • Nagata K.
        • Iwase M.
        • Murohara T.
        • Yokota M.
        Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography.
        Circulation. 2004; 110: 3808-3814
        • Izawa H.
        • Yokota M.
        • Nagata K.
        • Iwase M.
        • Sobue T.
        Impaired response of left ventricular relaxation to exercise-induced adrenergic stimulation in patients with hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 1996; 28: 1738-1745
        • Saloux E.
        • Labombarda F.
        • Pellissier A.
        • Anthune B.
        • Dugué A.E.
        • Provost N.
        • Allain P.
        • De Craene M.
        • Milliez P.
        • Manrique A.
        Diagnostic value of three-dimensional contrast-enhanced echocardiography for left ventricular volume and ejection fraction measurement in patients with poor acoustic windows: a comparison of echocardiography and magnetic resonance imaging.
        J Am Soc Echocardiogr. 2014; 27: 1029-1040