Key result
In post-heart transplant patients with normal ejection fraction, exercise testing revealed a 58% prevalence of exercise-induced heart failure, with left ventricular mass index acting as an independent predictor (OR 1.23 per 5 g/m2 increase).
Cross-Sectional (n=81)
No
Effect estimate: OR 1.23 (95% CI 1.04-1.45)
p-value: p=0.019
May warrant exercise testing in post-transplant surveillance despite normal EF; leaves open whether LVMI modification improves outcomes.
AIM: Post-heart transplant patients are at increased risk of diastolic dysfunction. The aim of this study was to assess the prevalence of isolated only exercise-induced heart failure with normal ejection fraction (HFNEF) in heart transplant recipients. METHODS AND RESULTS: To determine pulmonary capillary wedge pressure (PCWP) at rest and during exercise, 81 patients after orthotopic heart transplantation with normal left ventricular ejection fraction (LVEF) underwent exercise right heart catheterization with simultaneous exercise echocardiography. Based on PCWP values, the patients were divided into three groups. Twenty-one patients had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise < 25 mmHg, prevalence 26%). Forty-seven subjects were found to have only exercise-induced HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise ≥ 25 mmHg, prevalence 58%). Thirteen patients had HFNEF already at rest (PCWP ≥ 15 mmHg at rest, prevalence 16%). Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF. CONCLUSIONS: In heart transplant recipients with normal LVEF, there is a high prevalence of exercise-induced HFNEF. LV mass index adjusted for allograft age is predictive of exercise-induced HFNEF.
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Meluzı́n et al. (2014) conducted a cross-sectional in Post-heart transplant patients with normal left ventricular ejection fraction (n=81). Exercise right heart catheterization with simultaneous exercise echocardiography was evaluated on Prediction of exercise-induced HFNEF by left ventricular mass index (per 5 g/m2 increase) (OR 1.23, 95% CI 1.04-1.45, p=0.019). In post-heart transplant patients with normal ejection fraction, exercise testing revealed a 58% prevalence of exercise-induced heart failure, with left ventricular mass index acting as an independent predictor (OR 1.23 per 5 g/m2 increase).
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