BIOLOGIC AND THERAPEUTIC ADVANCES IN HEART TRANSPLANTATION I

M.K. Lizak¹, M. Zakliczynski², A. Jarosz³, M. Zembala^4
1Cardiology, Congenital Heart Disease And Electrotherapy, Silesian Centre for Heart Disease, Zabrze/POLAND, ²Dept. Of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze/POLAND, ³, Silesian Medical University, Zabrze/POLAND, ⁴Cardiac Surgery And Transplantation, Silesian Center for Heart Diseases, Zabrze/POLAND

Body: Introduction

Restrictive pattern in pulmonary function tests is commonly associated with chronic heart failure (CHF), however, its prognostic value in CHF patients is poorly documented. The utility of the Lower Limit of Normal (LLN) in spirometry interpretation in CHF patients has not been evaluated yet. The focus of this study was to examine the impact of pulmonary restrictive changes defined accordingly to the classic or LLN criteria on mortality and morbidity in CHF patients with peak oxygen consumption (PeakVO2) above the cut-off point for heart transplantation listing.

Methods

171 consecutive CHF patients on beta-antagonist treatment with PeakVO2 above 12ml/kg/min (147 men, 49±9 years, BMI 25.5±3.5; LVEF 26±8%, 51% ischemic) evaluated in the heart transplantation clinic were divided into groups basing on their spirometry results:
Group 1 (N=129) – no restriction accordingly to the classic criteria (forced expiratory volume in first second to forced vital capacity ratio - FEC%FVC>70 and inspiratory vital capacity - IVC%>70),
Group 2 (N=12) – presence of restrictive changes accordingly to the classic criteria (FEV1%FVC>70 and IVC%≤70),
Group 3 (N=90) – no restriction accordingly to the LLN criteria (FEV1%FVC>LLN and IVC>LLN), Group 4 (N=26) – presence of restrictive changes accordingly to the LLN criteria (FEV1%FVC>LLN and IVC≤LLN).
Control group (N=30) - PeakVO2>20ml/kg/min and the absence of restriction defined by classic criteria or obturation defined as FEV1%FVC<70.

The LLN is set at the 5th percentile of the normal distribution of spirometry values in the refference population and is specific to each patient’s age, sex and height.
The end-points were: time to death, 1 and 2-years mortality, number of cardiac and all-cause hospitalisations, and mean duration of cardiac and all-cause hospitalisations.
Chi-square test, U Mann-Whitney test and Kaplan-Meier survival curves analysis were performed. P<0.05 was considered significant.

Results

While groups 1 and 3 did not differ from the control group, the Kaplan-Meier analysis showed significant reduction of survival in groups 2 and 4 with the steepest Kaplan-Meier curve slope between 6 and 12 months, which was also mirrored in a significantly higher 1-year and 2-years mortality in group 4 (19,2 and 40,9%; control group: 0% and 0% accordingly) and 2-years motality in group 2 (40,0%). In neither of the groups the hospitalisation number or duration time differed from the Control Group.
Conclusion

Restrictive pattern in pulmonary function tests worsens survival prognosis in CHF patients with PeakVO2 above the cut-off point for OHT listing.

Disclosure: All authors have declared no conflicts of interest.