SYSTOLIC AND DIASTOLIC VENTRICULAR PERFORMANCE AT REST AND DURING EXERCISE IN HEART-TRANSPLANT RECIPIENTS

  • 1 March 1988
    • journal article
    • research article
    • Vol. 7  (2) , 145-151
Abstract
Left ventricular dysfunction has been described in the transplanted heart. To further define these abnormalities in cardiac performance and relate for the first time diastolic to systolic function in the transplanted heart, we investigated 28 clinically stable recipients of orthotopic heart transplantation. Patients underwent blood pool radionuclide angiography performed at rest early after transplantation. Patients underwent blood pool radionuclide angiography performed at rest early after transplantation (18 .+-. 13 days, mean .+-. SD) and at rest and at exercise late after transplantation (248 .+-. 194 days). Systolic ventricular performance was assessed by right and left ventricular ejection fractions, whereas diastolic left ventricular function was evaluated by the peak diastolic filling rate and its time of occurrence. Early after transplantation the left ventricular ejection fraction (54.0% .+-. 6.0%) was significantly lower (P < 0.001) than that of normal subjects of similar ages (61% .+-. 6.6%). Mean right ventricular ejection fraction (47% .+-. 6.0%) was comparable with that of normal subjects (49% .+-. 4%) and abnormal in only three of 21 patients. Rest peak diastolic filling rate and time to peak diastolic filling rate were comparable with values from normal subjects in our laboratory. Late after transplantation resting left and right ventricular ejection fractions; peak diastolic filling rate, and time to peak diastolic filling rate were similar to the values found early after transplantation. During exercise significant increases occurred in the left ventricular ejection fraction (P < 0.02), the right ventricular ejection fraction (P < 0.02), and the peak diastolic filling rate (P < 0.001). Peak exercise values attained by left and right ventricular ejection fractions, however, were significantly lower than those of normal subjects (P < 0.001). In conclusion, recipients of orthotopic heart transplantation without evidence of significant cardiac rejection have normal right ventricular systolic function, normal to mildly abnormal left ventricular systolic performance, and normal diastolic filling properties, as determined by radionuclide angiography. Ventricular functional reserve during exercise is significantly less than in normal subjects. These findings suggest that abnormalities seen postoperatively in the nonrejecting transplanted heart are subtle.

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