High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Jaroslav Meluzin,Helena Podrouzkova,Radka Stepanova,Petr Nemec,Pavel Leinveber,Jan Krejci,Lenka Spinarova,Petr Hude,Helena Bedanova

doi:10.5507/bp.2013.095

Abstract

Post-heart transplant patients are at increased risk of diastolic dysfunction. The aim of this study was to assess the prevalence of isolated only exercise-induced heart failure with normal ejection fraction (HFNEF) in heart transplant recipients. To determine pulmonary capillary wedge pressure (PCWP) at rest and during exercise, 81 patients after orthotopic heart transplantation with normal left ventricular ejection fraction (LVEF) underwent exercise right heart catheterization with simultaneous exercise echocardiography. Based on PCWP values, the patients were divided into three groups. Twenty-one patients had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise < 25 mmHg, prevalence 26%). Forty-seven subjects were found to have only exercise-induced HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise ≥ 25 mmHg, prevalence 58%). Thirteen patients had HFNEF already at rest (PCWP ≥ 15 mmHg at rest, prevalence 16%). Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF. In heart transplant recipients with normal LVEF, there is a high prevalence of exercise-induced HFNEF. LV mass index adjusted for allograft age is predictive of exercise-induced HFNEF.

Highlights

Heart failure with normal left ventricular ejection fraction (HFNEF) is a frequent disease affecting up to 50% of patients with clinical features of heart failure[1]
Heart transplant recipients frequently suffer from a number of risk factors of diastolic dysfunction such as hypertension, Left ventricular (LV) hypertrophy, myocardial fibrosis, diabetes mellitus, obesity, post-transplant vasculopathy, etc. and, are at a high risk of exercise-induced HFNEF
Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be the independent predictor of exercise-induced HFNEF

Summary

Introduction

Heart failure with normal left ventricular ejection fraction (HFNEF) is a frequent disease affecting up to 50% of patients with clinical features of heart failure[1]. Even if their risk of death is lower than that of patients with heart failure and reduced left ventricular ejection fraction (LVEF), the absolute mortality of patients with HFNEF is still high[2] and requires new approaches in the prevention and treatment to improve prognosis. The exercise may be useful in post heart transplant patients with unexplained exertional dyspnea or fatigue. The aim of our study was to assess the prevalence of isolated, only exercise-induced HFNEF in patients after orthotopic heart transplantation and to determine independent predictors of exercise HFNEF development

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Discussion

Conclusion