Author + information
- Received September 18, 1990
- Revision received June 7, 1991
- Accepted July 1, 1991
- Published online January 1, 1992.
- Angelika Costard-Jäckle, MD and
- Michael B. Fowler, MB, MRCP, FACC∗
- ↵∗Address for reprints: Michael B. Fowler, MB, MRCP, Division of Cardiovascular Medicine, CVRC 295, Stanford University Medical Center, Stanford, California 94305.
Patients with pulmonary hypertension are at risk of developing fatal right heart failure after heart transplantation. To evaluate this risk potential, candidates for heart transplantation are screened by measuring rest right heart pressures and the response to nitroprusside. To test the validity of this approach, the influence of pretransplantation right heart catheterization data on outcome after transplantation was analyzed in 293 of 301 consecutive patients.
Patients with a pulmonary vascular resistance >2.5 Wood units measured at baseline study had a 3-month mortality rate of 17.9% compared with 6.9% in patients with resistance ≤ 2.5 units (p < 0.02). Patients with a pulmonary vascular resistance > 2.5 units at baseline study could be differentiated further according to their hemodynamic response to nitroprusside; those whose resistance could be reduced to ≤ 2.5 units with a stable systemic systolic pressure ≥ 85 mm Hg had a 3-month mortality rate of only 3.8%. In contrast, patients whose pulmonary vascular resistance could not be reduced to < 2.5 units, and those whose resistance could be reduced to ≤ 2.5 units but only at the expense of systemic hypotension (systolic pressure ≤ 85 mm Hg) had a 3-month mortality rate of 40.6% and 27.5%, respectively. Furthermore, all 10 patients who died of right heart failure belonged to the latter two groups.
These findings confirm the value of right heart hemodynamic measurements and the response to nitroprusside in predicting early mortality after heart transplantation and, in particular, mortality due to right heart failure. Valid risk stratification based on the hemodynamic response to nitroprusside requires consideration of the concomitant change in systemic pressure.
- Received September 18, 1990.
- Revision received June 7, 1991.
- Accepted July 1, 1991.