Clinical and Hemodynamic profile of patients with advanced heart failure considered for heart transplantation

Introduction. The present study evaluated the clinical and hemodynamic situation of patients with advanced heart failure considered for heart transplantation (HT) to examine the possible impact of prior cardiac disease. Methods. We analyzed the pretransplant clinical, echocardiographic, and hemodynamic parameters of 422 consecutive HT patients. Pediatric and heart plus lung transplants were excluded, as were retransplantations. The results were compared by dividing the patients into three groups according to the background heart disease that led to HT: ischemic heart disease (IHD), dilated myocardiopathy (DMC), or valvular disease. Results. Differences were observed in the baseline characteristics according to the type of heart disease. Male gender, hypertension, and diabetes were more frequent among IHD, while DMC patients tended to be younger. There were no differences in the clinical parameters such as liver and kidney function, in the functional class, or in the need for inotropic treatment over the days prior to transplantation. Likewise, no differences were recorded in the hemodynamic parameters, such as pulmonary pressure, pulmonary vascular resistance, or transpulmonary pressure gradient. As regards the echocardiographic parameters, the patients with DMC showed greater ventricular diameters and lesser ejection fractions for both ventricles. Conclusion. No important differences were recorded in the clinical situation or hemodynamic parameters of patients with advanced heart failure accepted for transplantation, according to the background cardiac disease. This observation could be due to the homogenization by strict transplant waiting list inclusion criteria.