open access

Vol 21, No 5 (2014)
Original articles
Published online: 2014-10-29
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Prognostic value of pulmonary hemodynamic parameters in cardiac transplant candidates

Małgorzata Sobieszczańska-Małek, Tomasz Zieliński, Walerian Piotrowski, Jerzy Korewicki, on behalf of the participants of POLKARD-HF
DOI: 10.5603/CJ.a2014.0015
·
Cardiol J 2014;21(5):532-538.

open access

Vol 21, No 5 (2014)
Original articles
Published online: 2014-10-29

Abstract

Background: Pulmonary hypertension is a contradiction for heart transplantation (HTx). The aim of the study was to examine prognostic significance of pulmonary hemodynamic variables in patients with severe chronic heart failure (HF) considered for HTx.

Methods: Patients with HF were qualified to HTx in Poland. We measured pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), transpulmonary gradient (TPG), cardiac output (CO), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). We performed biochemical evaluation, 6-min walking test, VO2max. Death or emergency HTx were assumed as the endpoints in the follow-up. Death or any kind of HTx were considered an end of observation. Survival analysis was conducted using Kaplan-Meier curves (long rank test with strait defined by terciles of analyzed hemodynamic parameters).

Results: Six hundred and fifty-eight patients were qualified to HTx between 2003 and 2007. The mean follow-up: 601 days. 87.8% male. Mean age was under 50, III and IV NYHA class. Mean PASP was 44.3 ± 16.9 mm Hg, TPG 10.0 ± 6.6 mm Hg and PVR 2.9 mm Hg, PCWP20.9 ± 9.3 mm Hg. PASP and PCWP had influence on survival or emergency HTx. There was a significant difference in survival between patients with PCWP > 25 mm Hg and PCWP < 25 mm Hg. The worst prognosis was with PASP higher than 50 mm Hg. One-, two-, and three-year survival was 75%, 58% and 48% compared to patients with PASP < 35 mm Hg (80%, 70%, and 68%, respectively).

Conclusions: In patients qualified to HTx, pathological values of pulmonary hemodynamic parameters have a significant influence on survival. The worst prognosis have patients with PASP > 50 mm Hg, and PCWP > 25 mm Hg. Pulmonary hemodynamic parameters are important during allocation process to HTx.

Abstract

Background: Pulmonary hypertension is a contradiction for heart transplantation (HTx). The aim of the study was to examine prognostic significance of pulmonary hemodynamic variables in patients with severe chronic heart failure (HF) considered for HTx.

Methods: Patients with HF were qualified to HTx in Poland. We measured pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), transpulmonary gradient (TPG), cardiac output (CO), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). We performed biochemical evaluation, 6-min walking test, VO2max. Death or emergency HTx were assumed as the endpoints in the follow-up. Death or any kind of HTx were considered an end of observation. Survival analysis was conducted using Kaplan-Meier curves (long rank test with strait defined by terciles of analyzed hemodynamic parameters).

Results: Six hundred and fifty-eight patients were qualified to HTx between 2003 and 2007. The mean follow-up: 601 days. 87.8% male. Mean age was under 50, III and IV NYHA class. Mean PASP was 44.3 ± 16.9 mm Hg, TPG 10.0 ± 6.6 mm Hg and PVR 2.9 mm Hg, PCWP20.9 ± 9.3 mm Hg. PASP and PCWP had influence on survival or emergency HTx. There was a significant difference in survival between patients with PCWP > 25 mm Hg and PCWP < 25 mm Hg. The worst prognosis was with PASP higher than 50 mm Hg. One-, two-, and three-year survival was 75%, 58% and 48% compared to patients with PASP < 35 mm Hg (80%, 70%, and 68%, respectively).

Conclusions: In patients qualified to HTx, pathological values of pulmonary hemodynamic parameters have a significant influence on survival. The worst prognosis have patients with PASP > 50 mm Hg, and PCWP > 25 mm Hg. Pulmonary hemodynamic parameters are important during allocation process to HTx.

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Keywords

pulmonary hypertension, heart transplantation

About this article
Title

Prognostic value of pulmonary hemodynamic parameters in cardiac transplant candidates

Journal

Cardiology Journal

Issue

Vol 21, No 5 (2014)

Pages

532-538

Published online

2014-10-29

DOI

10.5603/CJ.a2014.0015

Bibliographic record

Cardiol J 2014;21(5):532-538.

Keywords

pulmonary hypertension
heart transplantation

Authors

Małgorzata Sobieszczańska-Małek
Tomasz Zieliński
Walerian Piotrowski
Jerzy Korewicki
on behalf of the participants of POLKARD-HF

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