Left and right ventricular functional dynamics determined by echocardiograms before and after lung transplantation

Tomoko S. Kato, Hilary F. Armstrong, P. Christian Schulze, Matthew Lippel, Atsushi Amano, Maryjane Farr, Matthew Bacchetta, Matthew N. Bartels, Marco R. Di Tullio, Shunichi Homma, Donna Mancini

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6% to 41.5 ± 2.7%, RV strain: -15.5 ± 2.9% to -18.0 ± 2.1%, RV E/E′: 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%, p = 0.385); however, 20 patients (30%) showed >10% decrease in LVEF after LT (61.5 ± 6.1% to 47.3 ± 4.2%, p <0.001) and an increase in LV E/E′ (11.8 ± 1.8 to 12.9 ± 2.2, p = 0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E′ was associated with decrease in LVEF after LT (odds ratio 1.381, 95% confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95% confidence interval 1.088 to 1.614, p = 0.002). Although RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.

Original languageEnglish (US)
Pages (from-to)652-659
Number of pages8
JournalAmerican Journal of Cardiology
Volume116
Issue number4
DOIs
StatePublished - Aug 15 2015
Externally publishedYes

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Lung Transplantation
Right Ventricular Function
Left Ventricular Function
Odds Ratio
Confidence Intervals
Patient Rights
Exercise Test
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left and right ventricular functional dynamics determined by echocardiograms before and after lung transplantation. / Kato, Tomoko S.; Armstrong, Hilary F.; Schulze, P. Christian; Lippel, Matthew; Amano, Atsushi; Farr, Maryjane; Bacchetta, Matthew; Bartels, Matthew N.; Di Tullio, Marco R.; Homma, Shunichi; Mancini, Donna.

In: American Journal of Cardiology, Vol. 116, No. 4, 15.08.2015, p. 652-659.

Research output: Contribution to journalArticle

Kato, TS, Armstrong, HF, Schulze, PC, Lippel, M, Amano, A, Farr, M, Bacchetta, M, Bartels, MN, Di Tullio, MR, Homma, S & Mancini, D 2015, 'Left and right ventricular functional dynamics determined by echocardiograms before and after lung transplantation', American Journal of Cardiology, vol. 116, no. 4, pp. 652-659. https://doi.org/10.1016/j.amjcard.2015.05.027
Kato, Tomoko S. ; Armstrong, Hilary F. ; Schulze, P. Christian ; Lippel, Matthew ; Amano, Atsushi ; Farr, Maryjane ; Bacchetta, Matthew ; Bartels, Matthew N. ; Di Tullio, Marco R. ; Homma, Shunichi ; Mancini, Donna. / Left and right ventricular functional dynamics determined by echocardiograms before and after lung transplantation. In: American Journal of Cardiology. 2015 ; Vol. 116, No. 4. pp. 652-659.
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abstract = "Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6{\%} to 41.5 ± 2.7{\%}, RV strain: -15.5 ± 2.9{\%} to -18.0 ± 2.1{\%}, RV E/E′: 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0{\%} to 57.5 ± 9.7{\%}, p = 0.385); however, 20 patients (30{\%}) showed >10{\%} decrease in LVEF after LT (61.5 ± 6.1{\%} to 47.3 ± 4.2{\%}, p <0.001) and an increase in LV E/E′ (11.8 ± 1.8 to 12.9 ± 2.2, p = 0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E′ was associated with decrease in LVEF after LT (odds ratio 1.381, 95{\%} confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95{\%} confidence interval 1.088 to 1.614, p = 0.002). Although RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.",
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AU - Kato, Tomoko S.

AU - Armstrong, Hilary F.

AU - Schulze, P. Christian

AU - Lippel, Matthew

AU - Amano, Atsushi

AU - Farr, Maryjane

AU - Bacchetta, Matthew

AU - Bartels, Matthew N.

AU - Di Tullio, Marco R.

AU - Homma, Shunichi

AU - Mancini, Donna

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N2 - Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6% to 41.5 ± 2.7%, RV strain: -15.5 ± 2.9% to -18.0 ± 2.1%, RV E/E′: 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%, p = 0.385); however, 20 patients (30%) showed >10% decrease in LVEF after LT (61.5 ± 6.1% to 47.3 ± 4.2%, p <0.001) and an increase in LV E/E′ (11.8 ± 1.8 to 12.9 ± 2.2, p = 0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E′ was associated with decrease in LVEF after LT (odds ratio 1.381, 95% confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95% confidence interval 1.088 to 1.614, p = 0.002). Although RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.

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