Use of Cardiac Allografts With Mild and Moderate Left Ventricular Hypertrophy Can Be Safely Used in Heart Transplantation to Expand the Donor Pool
Sorel Goland, MD ,
Lawrence S.C. Czer, MD*,*,
Robert M. Kass, MD ,
Robert J. Siegel, MD*,
James Mirocha, MS,
Michele A. De Robertis, RN,
Jason Lee, BS,
Sharo Raissi, MD,
Wen Cheng, MD,
Gregory Fontana, MD and
Alfredo Trento, MD
* Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
Division of Cardiology, Kaplan Medical Center, Rehovot, Israel.
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Figure 1 Survival of Recipients of Donor Hearts With LVH and Without LVH and by Donor Age
(A) Recipients of donor hearts with left ventricular hypertrophy (LVH) and those without LVH had similar 30-day, 1-year, and 5-year survival rates. (B) Survival analysis of recipients of donor hearts with LVH and without LVH stratified by donor age revealed a trend for better survival among recipients of younger donors’ hearts with LVH and without LVH compared with older donors’ hearts with LVH and without LVH.
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Figure 2 Survival of Recipients of Donor Hearts With LVH by Echo, Both Echo and ECG, or by Donor History of HTN
(A) Survival of recipients of donor hearts with left ventricular hypertrophy (LVH) as determined by echocardiography (echo) alone did not differ from those determined by both echo and electrocardiogram (ECG). (B) For approximately the first 2.5 years post-transplant, almost identical survival was observed among recipients of donor LVH with and without donor history of hypertension (HTN); however, those with donor history of HTN have a trend for worse survival thereafter. Summary tables (insets) provide survival estimates (±SE) at 30 days, 1 year, and 5 years, respectively.
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Figure 3 Comparison of LV IVS and PW Thicknesses in Recipients of Donor Hearts With and Without LVH
(A) No significant differences of left ventricular (LV) interventricular septum (IVS) wall thickness in recipients of donor hearts with and without left ventricular hypertrophy (LVH) were obtained at 1- and 5-year follow-ups. (B) At follow-ups (1- and 5-year), wall thickness was similar in patients with donor LVH and those without LVH. PW = posterior wall.
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Figure 4 LVWT After HTx With Donor LVH, and LVH Prevalence With and Without Donor LVH After HTx
(A) Left ventricular wall thickness (LVWT) regression occurred in both interventricular septum and posterior wall at 1- and 5-year follow-ups. The p value refers to change from baseline to both 1- and 5-year follow-ups. (B) Recipients of donor hearts with LVH and without LVH had a similar percentage of patients with LVH at 1- and 5-year follow-ups. Abbreviations as in Figure 3.
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Figure 5 BP at 1 Year Post-HTx, and After Treatment in Recipients of Donor Hearts With and Without LVH
(A) Recipients of donor hearts with left ventricular hypertrophy (LVH) and without LVH had similar systolic and diastolic blood pressures at 1-year post-transplantation. (B) A similar distribution of treatment with ACEI and/or ARB and Ca channel blockers was found among patients with donor LVH and without LVH. ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; BP = blood pressure; Ca = calcium; HTx = heart transplantation.
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