Mild vs severe pulmonary hypertension before heart transplantation: Different effects on posttransplantation pulmonary hypertension and mortality

被引:69
作者
Chang, PP
Longenecker, JC
Wang, NY
Baughman, KL
Conte, JV
Hare, JM
Kasper, EK
机构
[1] Univ N Carolina, Dept Med, Chapel Hill, NC 27599 USA
[2] Univ N Carolina, Dept Cardiol, Chapel Hill, NC 27599 USA
[3] Johns Hopkins Univ, Sch Med, Dept Med, Div Cardiol, Baltimore, MD 21205 USA
[4] Johns Hopkins Univ, Sch Med, Div Internal Med, Baltimore, MD 21205 USA
[5] Johns Hopkins Univ, Sch Med, Div Cardiac Surg, Dept Surg, Baltimore, MD 21205 USA
关键词
D O I
10.1016/j.healun.2004.07.013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Pulmonary hypertension (PH) is common in severe heart failure, but the effect of mild PH on posttransplantation PH and survival after heart transplantation has not been well described. Methods: This cohort study examined preoperative and postoperative hemodynamics in 172 heart transplant recipients at Johns Hopkins Hospital followed for up to 15.1 years. PH was defined as pulmonary vascular resistance >= 2.5 Wood units, as measured during routine right heat catheterization; mild to moderate PH was defined as PVR between 2.5 and 4.9 Wood units; and severe PH was defined as PVR >= 5.0 Wood units. Results: Seventy-one patients (41.3%) had PH, mostly of mild/moderate severity (77.5%), at the last routine hemodynamic monitoring before transplantation (median time before transplantation, 2.7 months). During follow-up, 105 patients (62.9%) developed PH at some point after transplantation, and 48 patients died (cumulative incidence, 76.5%). Mild/moderate preoperative PH was associated with increased risk of posttransplantation PH at 1, 3, and 6 months, but not with later episodes of PH. Mild/moderate preoperative PH was not associated with a higher mortality rate, but each 1 Wood unit increase in preoperative PVR demonstrated a trend toward increased mortality. Severe preoperative PH was associated with death within the first year after adjusting for potential confounders, but not with overall mortality or mortality at other time points. Conclusions: Mild to moderate preoperative PH is associated with increased risk of developing early but not late posttransplantation PH and may suggest different management strategies. Although PH was not consistently associated with mortality, increasing severity of the preoperative PH suggests potentially worse prognosis.
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页码:998 / 1007
页数:10
相关论文
共 27 条
  • [1] PULMONARY-HYPERTENSION PREDICTS MORTALITY AND MORBIDITY IN PATIENTS WITH DILATED CARDIOMYOPATHY
    ABRAMSON, SV
    BURKE, JF
    KELLY, JJ
    KITCHEN, JG
    DOUGHERTY, MJ
    YIH, DF
    MCGEEHIN, FC
    SHUCK, JW
    PHIAMBOLIS, TP
    [J]. ANNALS OF INTERNAL MEDICINE, 1992, 116 (11) : 888 - 895
  • [2] Billingham M E, 1990, J Heart Transplant, V9, P587
  • [3] BOURGE RC, 1991, J THORAC CARDIOV SUR, V101, P432
  • [4] Pulmonary hypertension and risk of death in cardiomyopathy Patients with myocarditis are at higher risk
    Cappola, TP
    Felker, GM
    Kao, WHL
    Hare, JM
    Baughman, KL
    Kasper, EK
    [J]. CIRCULATION, 2002, 105 (14) : 1663 - 1668
  • [5] Reevaluating the significance of pulmonary hypertension before cardiac transplantation: Determination of optimal thresholds and quantification of the effect of reversibility on perioperative mortality
    Chen, JM
    Levin, HR
    Michler, RE
    Prusmack, CJ
    Rose, EA
    Aaronson, KD
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1997, 114 (04) : 627 - 634
  • [6] Recipient selection in cardiac transplantation: Contraindications and risk factors for mortality
    Cimato, TR
    Jessup, M
    [J]. JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2002, 21 (11) : 1161 - 1173
  • [7] INFLUENCE OF PREOPERATIVE PULMONARY-ARTERY PRESSURE ON MORTALITY AFTER HEART-TRANSPLANTATION - TESTING OF POTENTIAL REVERSIBILITY OF PULMONARY-HYPERTENSION WITH NITROPRUSSIDE IS USEFUL IN DEFINING A HIGH-RISK GROUP
    COSTARDJACKLE, A
    FOWLER, MB
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 19 (01) : 48 - 54
  • [8] Impact of mild pulmonary hypertension on mortality and pulmonary artery pressure profile after heart transplantation
    Delgado, JF
    Gómez-Sánchez, MA
    de la Calzada, CS
    Sánchez, V
    Escribano, P
    Hernández-Afonso, J
    Tello, R
    de la Cámara, AG
    Rodríguez, E
    Rufilanchas, JJ
    [J]. JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2001, 20 (09) : 942 - 948
  • [9] ERICKSON KW, 1990, J HEART TRANSPLANT, V9, P526
  • [10] Reversibility of pulmonary hypertension in patients evaluated for orthotopic heart transplantation: Importance in the postoperative morbidity and mortality
    Espinoza, C
    Manito, N
    Roca, J
    Castells, E
    Mauri, J
    Ribas, M
    Claret, G
    [J]. TRANSPLANTATION PROCEEDINGS, 1999, 31 (06) : 2503 - 2504