Serial assessment of left ventricular function and mass after orthotopic heart transplantation: A 4-year longitudinal study

Long-term changes in left ventricular performance and geometry in the transplanted human heart have been incompletely described. Therefore, two-dimensional echocardiograms were performed on 22 recipients of an orthotopic heart transplant at 1 month (32 ± 20 days), 1 year (11 ± 3 months) and 4 years (54 ± 9 months) after transplantation. All studies were performed at a time when the patient had no pathologic evidence of rejection. Ten healthy men served as a normal control group. Over 4 years of follow-up, mean systolic blood pressure in the study patients increased from 121 ± 12 (p = NS vs. values in the control group) to 139 ± 11 mm Hg (p < 0.05 vs. both control values and values at 1 month); mean diastolic blood pressure increased from 72 ± 7 (p = NS vs. normal values in the control group) to 93 ± 8 mm Hg (p < 0.05 vs. both control values and values at 1 month). Left ventricular end-systolic volume increased from 42 ± 10 (p = NS vs. control values) to 51 ± 14 ml (p < 0.05 vs. both control values and values at 1 month) and end-diastolic volume increased from 103 ± 28 (p = NS vs. control values) to 112 ± 27 ml (p < 0.05 vs. control values) over 4 years. Left ventricular mass and ejection fraction did not change significantly within the patient cohort and remained similar to that found in the control group. End-systolic circumferential wall stress increased from 142 ± 29 (p = NS vs. control values) to 174 ± 34 kdynes/cm2(p < 0.05 vs. both control values and values at 1 month). Thus, although ejection fraction remained within the normal range over a 4-year follow-up period, significant increases in volume and end-systolic wall stress developed in the transplanted left ventricle in the absence of increases in mass.