Left ventricle geometry remolding after heart transplantation: A two-dimensional ultrasound study

Abstract

The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass (LVM), and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation (HT). The purpose of this study was to dynamically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end diastole were measured and the relative wall thickness (RWT), left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index (LVMI) and RWT. The HT patients were divided into three groups according to the time length after surgery: A (3 months postoperatively), B (6 months postoperatively) and C (12 months postoperatively). We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients (16%) in group A had concentric remodeling. Nine patients (34.62%) in group B had reconstruction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients (62.5%) had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hypertrophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hypertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.

Keywords

two-dimensional echocardiography / heart transplantation / left ventricular remodeling / left ventricular hypertrophy

References

[1] McKoyRC, UretskyBF, KormosR, et al.. Left ventricular hypertrophy in cyclosporine-induced systemic hypertension after cardiac transplantation. Am J Cardiol, 1988, 62(16): 1140-1142

[2] VenturaHO, LavieCJ, MesserliFH, et al.. Cardiovascular adaptation to cyclosporine-induced hypertension. J Hum Hypertens, 1994, 8(4): 233-237

[3] CalòL, SempliciniA, DavisPA, et al.. Cyclosporin-induced endothelial dysfunction and hypertension: are nitric oxide system abnormality and oxidative stress involved?. Transpl Int, 2000, 13(Suppl1): 413-418

[4] VerdecchiaP, CariniG, CircoA, et al.. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol, 2001, 38(7): 1829-1835

[5] VerdecchiaP, PorcellatiC, ReboldiG, et al.. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation, 2001, 104(17): 2039-2044

[6] GoodroeR, BonnemaD, LunsfordS, et al.. Severe left ventricular hypertrophy 1 year after transplant predicts mortality in cardiac transplant recipients. J Heart Lung Transplant, 2007, 26(2): 145-151

[7] TalerSJ, TextorSC, CanzanelloVJ, et al.. Cyclosporin-induced hypertension: incidence, pathogenesis, and management. Drug Saf, 1999, 20(5): 437-449

[8] LangRM, BierigM, DevereuxRB. Recommendations for chamber quantification. J Am Soc Echocardiogr, 2005, 18(12): 1440-1463

[9] TrulockEP, EdwardsLB, TaylorDO, et al.. Registry of the International Society for Heart and Lung Transplantation: twenty-second official adult lung and heart-lung transplant report—2005. J Heart Lung Transplant, 2005, 24(8): 956-967

[10] LiaoY, CooperRS, Durazo-ArvizuR, et al.. Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol, 1997, 29(3): 641-647

[11] HaiderAW, LarsonMG, BenjaminEJ, et al.. Increased left ventricular mass and hypertrophy are associated with an increased risk for sudden death. J Am Coll Cardiol, 1998, 32(5): 1454-1459

[12] BorowKM, NeumannA, ArensmanFW, et al.. Left ventricular contractility and contractile reserve in humans after cardiac transplantation. Circulation, 1985, 71(5): 866-872

[13] MclaughlinPR, KleimanJH, MartinRP, et al.. The effect of exercise arterial pacing on left ventricular volume and contractility in patients with innervated and denervated hearts. Circulation, 1978, 58(3): 476-483

[14] StinsonEB, GrieppRB, ClarkDA, et al.. Cardiac transplantation in man. 8. Survival and function. J Thorac Cardiivasc Surg, 1970, 60(3): 303-321

[15] SagarKB, HastilloA, WolfgangTC, et al.. Left ventricular mass by M-mode echocardiography in cardiac transplant patients with acute rejection. Circulation, 1982, 64(supplII): 211-216

[16] SchwitterJ, De MarcoT, GlobitsS, et al.. Influence of felodipine on left ventricular hypertrophy and systolic function in orthotopic heart transplant recipients: possible interaction with cyclosporine medication. J Heart Lung Transplant, 1999, 18(10): 1003-1013

[17] GlobitsS, DeMarcoT, SchwitterJ, et al.. Assessment of early left ventricular remodeling in orthotopic heart transplant recipients with cine magnetic resonance imaging: potential mechanisms. J Heart Lung Transplant, 1997, 16(5): 504-510

[18] CorcosT, TamburinoC, LegerP, et al.. Early and late hemodynamic evaluation after cardiac transplantation: A study of 28 cases. JACC, 1988, 11(2): 264-269

[19] CzerskaB, StewartRW, HobbsRE, et al.. Hypertension and left ventricular hypertrophy in black vs. white heart transplant patients 1 year after surgery. Ethn Dis, 1991, 1(4): 335-341

[20] PeuraJL, ZileMR, FeldmanDS, et al.. Effects of conversion from cyclosporin to tacrolimus on left ventricular structure in cardiac allograft recipients. J Heart Lung Transplant, 2005, 24(11): 1969-1972

[21] SchwitterJ, DeMarcoT, GlobitsS, et al.. Influence of felodipine on left ventricular hypertrophy and systolic function in orthotopic heart transplant recipients: possible interaction with cyclosporin medication. J Heart Lung Transplant, 1999, 18(10): 1003-1013

[22] GuoJH. Heart transplantation and electrocardiogram. Lin Chuang Xin Dian Xue Za Zhi (Chinese), 2004, 13(3): 223-229