Left ventricular function, tricuspid incompetence, and incidence of coronary artery disease late after orthotopic heart transplantation

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Abstract
Functional results and data concerning the incidence and severity ofgraft atherosclerosis (GASC) and tricuspid incompetence (TI) in theintermediate term after orthotopic heart transplantation (HTX) are stillstriking. We examined 92 patients 1, 2, and 3 years after HTX by right andleft heart catheterization in order to evaluate pump function, the statusof the coronary arteries and the extend of TI, using a double indicatorthermodilation technique. Mean left ventricular volumes and ejectionfraction were normal 1 and 2 years post-transplant. The incidence of GASCwas 8/87 (9.2%) at 1, and 11/92 (12%) at 2 years. It was more frequent(16%) in patients with preexisting coronary artery disease (IHD) than inpatients with underlying dilative cardiomyopathy (DCM) (11%). At the end ofthe 1st postoperative year, 62% of patients were free of TI, whereas only38% had normal valve function 2 years posttransplant. In 9/14 (64%) ofpatients, consecutively assessed at 1 and 2 years, TI had increased betweenboth investigations. Preoperative haemodynamics, the number ofendomyocardial biopsies and rejection episodes as well as preoperativecardiac size did not correlate with TI. Left ventricular volumes andejection fraction are normal in the intermediate term after HTX. Theincidence of GASC was less than 10% at 1 year and did not significantlyincrease thereafter. TI is a frequent and yet unexplained finding after HTXshowing a considerable tendency to increase with time, but with little ornot haemodynamic consequence.

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