Doppler-echocardiographic 10-years follow-up after orthotopic heart transplantation – the Münster single center experience

Purpose: Serial Doppler-echocardiographic examinations are standard in monitoring patients after orthotopic heart transplantation (oHTx). However, literature only provides sparse information about long term course of echocardiographic data after oHTx.

Methods: Patients undergoing oHTX were serially followed by echocardiography. Clinical caracteristics, Doppler-echocardiographic parameters and long-term survival were correlated.

Results: Detailed data of 5597 Doppler-echocardiographic examinations of 186 consecutive patients transplanted could be analyzed. 36 patients of the cohort died during follow-up. Kaplan-Meier-analyses revealed a negative association for survival with impaired global left ventricular (LV)-function and impaired regional antero-septal LV-function (defined as global EF <60%, p<0.002; and as presence of regional wall motion abnormalities, p<0.0008). In long-term follow-up, diastolic function did not show relevant impairment except a minimal acceleration of the E-wave of mitral inflow. Already within the first year after oHTx ultrasound based estimations of LV-mass of the transplanted hearts showed increased values as compared to normal population. A larger increase of LV-mass during follow-up had a negative impact on survival (p<0.03). Regurgitations of the atrioventricular valves with hemodynamic relevance were negatively associated with survival (p<0.03). Increased age at the time point of heart transplantion and survival correlated inversely.

Conclusion: Preserved global and regional LV function is an echocardiographic predictor for a good prognosis after oHTX. Any global or regional impairment of LV transplant function or appearance of atrioventricular regurgitation worsens prognosis after oHTx. Ultrasound based estimations of heart weight are correlated with survival and therefore can be useful to monitor immunsupression and antihypertensive therapy.