TY - JOUR
T1 - Cardiac allograft hypertrophy is associated with impaired exercise tolerance after heart transplantation
AU - Raichlin, Eugenia
AU - Al-Omari, Malik A.
AU - Hayes, Courtney L.
AU - Edwards, Brooks S.
AU - Frantz, Robert P.
AU - Boilson, Barry A.
AU - Clavell, Alfredo L.
AU - Rodeheffer, Richard J.
AU - Schirger, John A.
AU - Kushwaha, Sudhir S.
AU - Allison, Thomas G.
AU - Pereira, Naveen L.
N1 - Funding Information:
This study was supported in part by NIH (National Institute of Health; Bethesda, MD) Grant HL 84904 from the Heart Failure Clinical Research Network , a Marie Ingalls Cardiovascular Career Development Award (Mayo Clinic, Rochester, MN) and NIH Grants UL1RR24150 (to N.L.P.).
PY - 2011/10
Y1 - 2011/10
N2 - Background: Exercise performance, an important aspect of quality of life, remains limited after heart transplantation (HTx). This study examines the effect of cardiac allograft remodeling on functional capacity after HTx. Methods: The total cohort of 117 HTx recipients, based on echocardiographic determination of left ventricle mass and relative wall thickness at 1 year after HTx, was divided into 3 groups: (1) NG, normal geometry; (2) CR, concentric remodeling; and (3) CH, concentric hypertrophy. Cardiopulmonary exercise testing was performed 5.03 ± 3.08 years after HTx in all patients. Patients with acute rejection or significant graft vasculopathy were excluded. Results: At 1 year post-HTx, 30% of patients had CH, 55% had CR and 15% had NG. Exercise tolerance, measured by maximum achieved metabolic equivalents (4.62 ± 1.44 vs 5.52 ± 0.96 kcal/kg/h), normalized peak Vo 2 (52 ± 14% vs 63 ± 12%) and Ve/Vco 2 (41 ± 17 vs 34 ± 6), was impaired in the CH group compared with the NG group. A peak Vo 2 ≤14 ml/kg/min was found in 6%, 22% and 48% of patients in the NG, CR and CH groups, respectively (p = 0.01). The CH pattern was associated with a 7.4-fold increase in relative risk for a peak Vo 2 ≤14 ml/kg/min compared with NG patients (95% confidence interval 1.1 to 51.9, p = 0.001). After multivariate analysis, a 1-year CH pattern was independently associated with a reduced normalized peak Vo 2 (p = 0.018) and an elevated Ve/Vco 2 (p = 0.035). Conclusions: The presence of CH at 1 year after HTx is independently associated with decreased normalized peak Vo 2 and increased ventilatory response in stable heart transplant recipients. The identification of CH, a potentially reversible mechanism of impairment in exercise capacity after HTx, may have major clinical implications.
AB - Background: Exercise performance, an important aspect of quality of life, remains limited after heart transplantation (HTx). This study examines the effect of cardiac allograft remodeling on functional capacity after HTx. Methods: The total cohort of 117 HTx recipients, based on echocardiographic determination of left ventricle mass and relative wall thickness at 1 year after HTx, was divided into 3 groups: (1) NG, normal geometry; (2) CR, concentric remodeling; and (3) CH, concentric hypertrophy. Cardiopulmonary exercise testing was performed 5.03 ± 3.08 years after HTx in all patients. Patients with acute rejection or significant graft vasculopathy were excluded. Results: At 1 year post-HTx, 30% of patients had CH, 55% had CR and 15% had NG. Exercise tolerance, measured by maximum achieved metabolic equivalents (4.62 ± 1.44 vs 5.52 ± 0.96 kcal/kg/h), normalized peak Vo 2 (52 ± 14% vs 63 ± 12%) and Ve/Vco 2 (41 ± 17 vs 34 ± 6), was impaired in the CH group compared with the NG group. A peak Vo 2 ≤14 ml/kg/min was found in 6%, 22% and 48% of patients in the NG, CR and CH groups, respectively (p = 0.01). The CH pattern was associated with a 7.4-fold increase in relative risk for a peak Vo 2 ≤14 ml/kg/min compared with NG patients (95% confidence interval 1.1 to 51.9, p = 0.001). After multivariate analysis, a 1-year CH pattern was independently associated with a reduced normalized peak Vo 2 (p = 0.018) and an elevated Ve/Vco 2 (p = 0.035). Conclusions: The presence of CH at 1 year after HTx is independently associated with decreased normalized peak Vo 2 and increased ventilatory response in stable heart transplant recipients. The identification of CH, a potentially reversible mechanism of impairment in exercise capacity after HTx, may have major clinical implications.
KW - cardiac allograft remodeling
KW - exercise intolerance
KW - exercise physiology
KW - heart transplantation
KW - left ventricular hypertrophy
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U2 - 10.1016/j.healun.2011.04.012
DO - 10.1016/j.healun.2011.04.012
M3 - Article
C2 - 21621424
AN - SCOPUS:80053328575
SN - 1053-2498
VL - 30
SP - 1153
EP - 1160
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 10
ER -