Mild vs severe pulmonary hypertension before heart transplantation: Different effects on posttransplantation pulmonary hypertension and mortality

Patricia P. Chang, J. Craig Longenecker, Nae Yuh Wang, Kenneth L. Baughman, John V. Conte, Joshua Hare, Edward K. Kasper

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Pulmonary hypertension (PH) is common in severe heart failure, but the effect of mild PH on posttransplantation PH and survival after heart transplantation has not been well described. Methods: This cohort study examined preoperative and postoperative hemodynamics in 172 heart transplant recipients at Johns Hopkins Hospital followed for up to 15.1 years. PH was defined as pulmonary vascular resistance <2.5 Wood units, as measured during routine right heat catheterization; mild to moderate PH was defined as PVR between 2.5 and 4.9 Wood units; and severe PH was defined as PVR <5.0 Wood units. Results: Seventy-one patients (41.3%) had PH, mostly of mild/moderate severity (77.5%), at the last routine hemodynamic monitoring before transplantation (median time before transplantation, 2.7 months). During follow-up, 105 patients (62.9%) developed PH at some point after transplantation, and 48 patients died (cumulative incidence, 76.5%). Mild/moderate preoperative PH was associated with increased risk of posttransplantation PH at 1, 3, and 6 months, but not with later episodes of PH. Mild/moderate preoperative PH was not associated with a higher mortality rate, but each 1 Wood unit increase in preoperative PVR demonstrated a trend toward increased mortality. Severe preoperative PH was associated with death within the first year after adjusting for potential confounders, but not with overall mortality or mortality at other time points. Conclusions: Mild to moderate preoperative PH is associated with increased risk of developing early but not late posttransplantation PH and may suggest different management strategies. Although PH was not consistently associated with mortality, increasing severity of the preoperative PH suggests potentially worse prognosis.

Original languageEnglish
Pages (from-to)998-1007
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume24
Issue number8
DOIs
StatePublished - Aug 1 2005
Externally publishedYes

Fingerprint

Heart Transplantation
Pulmonary Hypertension
Mortality
Transplantation
Hemodynamics
Catheterization
Vascular Resistance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Mild vs severe pulmonary hypertension before heart transplantation : Different effects on posttransplantation pulmonary hypertension and mortality. / Chang, Patricia P.; Longenecker, J. Craig; Wang, Nae Yuh; Baughman, Kenneth L.; Conte, John V.; Hare, Joshua; Kasper, Edward K.

In: Journal of Heart and Lung Transplantation, Vol. 24, No. 8, 01.08.2005, p. 998-1007.

Research output: Contribution to journalArticle

Chang, Patricia P. ; Longenecker, J. Craig ; Wang, Nae Yuh ; Baughman, Kenneth L. ; Conte, John V. ; Hare, Joshua ; Kasper, Edward K. / Mild vs severe pulmonary hypertension before heart transplantation : Different effects on posttransplantation pulmonary hypertension and mortality. In: Journal of Heart and Lung Transplantation. 2005 ; Vol. 24, No. 8. pp. 998-1007.
@article{66ae426e3302421fbda019d5b0acb15e,
title = "Mild vs severe pulmonary hypertension before heart transplantation: Different effects on posttransplantation pulmonary hypertension and mortality",
abstract = "Background: Pulmonary hypertension (PH) is common in severe heart failure, but the effect of mild PH on posttransplantation PH and survival after heart transplantation has not been well described. Methods: This cohort study examined preoperative and postoperative hemodynamics in 172 heart transplant recipients at Johns Hopkins Hospital followed for up to 15.1 years. PH was defined as pulmonary vascular resistance <2.5 Wood units, as measured during routine right heat catheterization; mild to moderate PH was defined as PVR between 2.5 and 4.9 Wood units; and severe PH was defined as PVR <5.0 Wood units. Results: Seventy-one patients (41.3{\%}) had PH, mostly of mild/moderate severity (77.5{\%}), at the last routine hemodynamic monitoring before transplantation (median time before transplantation, 2.7 months). During follow-up, 105 patients (62.9{\%}) developed PH at some point after transplantation, and 48 patients died (cumulative incidence, 76.5{\%}). Mild/moderate preoperative PH was associated with increased risk of posttransplantation PH at 1, 3, and 6 months, but not with later episodes of PH. Mild/moderate preoperative PH was not associated with a higher mortality rate, but each 1 Wood unit increase in preoperative PVR demonstrated a trend toward increased mortality. Severe preoperative PH was associated with death within the first year after adjusting for potential confounders, but not with overall mortality or mortality at other time points. Conclusions: Mild to moderate preoperative PH is associated with increased risk of developing early but not late posttransplantation PH and may suggest different management strategies. Although PH was not consistently associated with mortality, increasing severity of the preoperative PH suggests potentially worse prognosis.",
author = "Chang, {Patricia P.} and Longenecker, {J. Craig} and Wang, {Nae Yuh} and Baughman, {Kenneth L.} and Conte, {John V.} and Joshua Hare and Kasper, {Edward K.}",
year = "2005",
month = "8",
day = "1",
doi = "10.1016/j.healun.2004.07.013",
language = "English",
volume = "24",
pages = "998--1007",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "8",

}

TY - JOUR

T1 - Mild vs severe pulmonary hypertension before heart transplantation

T2 - Different effects on posttransplantation pulmonary hypertension and mortality

AU - Chang, Patricia P.

AU - Longenecker, J. Craig

AU - Wang, Nae Yuh

AU - Baughman, Kenneth L.

AU - Conte, John V.

AU - Hare, Joshua

AU - Kasper, Edward K.

PY - 2005/8/1

Y1 - 2005/8/1

N2 - Background: Pulmonary hypertension (PH) is common in severe heart failure, but the effect of mild PH on posttransplantation PH and survival after heart transplantation has not been well described. Methods: This cohort study examined preoperative and postoperative hemodynamics in 172 heart transplant recipients at Johns Hopkins Hospital followed for up to 15.1 years. PH was defined as pulmonary vascular resistance <2.5 Wood units, as measured during routine right heat catheterization; mild to moderate PH was defined as PVR between 2.5 and 4.9 Wood units; and severe PH was defined as PVR <5.0 Wood units. Results: Seventy-one patients (41.3%) had PH, mostly of mild/moderate severity (77.5%), at the last routine hemodynamic monitoring before transplantation (median time before transplantation, 2.7 months). During follow-up, 105 patients (62.9%) developed PH at some point after transplantation, and 48 patients died (cumulative incidence, 76.5%). Mild/moderate preoperative PH was associated with increased risk of posttransplantation PH at 1, 3, and 6 months, but not with later episodes of PH. Mild/moderate preoperative PH was not associated with a higher mortality rate, but each 1 Wood unit increase in preoperative PVR demonstrated a trend toward increased mortality. Severe preoperative PH was associated with death within the first year after adjusting for potential confounders, but not with overall mortality or mortality at other time points. Conclusions: Mild to moderate preoperative PH is associated with increased risk of developing early but not late posttransplantation PH and may suggest different management strategies. Although PH was not consistently associated with mortality, increasing severity of the preoperative PH suggests potentially worse prognosis.

AB - Background: Pulmonary hypertension (PH) is common in severe heart failure, but the effect of mild PH on posttransplantation PH and survival after heart transplantation has not been well described. Methods: This cohort study examined preoperative and postoperative hemodynamics in 172 heart transplant recipients at Johns Hopkins Hospital followed for up to 15.1 years. PH was defined as pulmonary vascular resistance <2.5 Wood units, as measured during routine right heat catheterization; mild to moderate PH was defined as PVR between 2.5 and 4.9 Wood units; and severe PH was defined as PVR <5.0 Wood units. Results: Seventy-one patients (41.3%) had PH, mostly of mild/moderate severity (77.5%), at the last routine hemodynamic monitoring before transplantation (median time before transplantation, 2.7 months). During follow-up, 105 patients (62.9%) developed PH at some point after transplantation, and 48 patients died (cumulative incidence, 76.5%). Mild/moderate preoperative PH was associated with increased risk of posttransplantation PH at 1, 3, and 6 months, but not with later episodes of PH. Mild/moderate preoperative PH was not associated with a higher mortality rate, but each 1 Wood unit increase in preoperative PVR demonstrated a trend toward increased mortality. Severe preoperative PH was associated with death within the first year after adjusting for potential confounders, but not with overall mortality or mortality at other time points. Conclusions: Mild to moderate preoperative PH is associated with increased risk of developing early but not late posttransplantation PH and may suggest different management strategies. Although PH was not consistently associated with mortality, increasing severity of the preoperative PH suggests potentially worse prognosis.

UR - http://www.scopus.com/inward/record.url?scp=23744500095&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23744500095&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2004.07.013

DO - 10.1016/j.healun.2004.07.013

M3 - Article

C2 - 16102433

AN - SCOPUS:23744500095

VL - 24

SP - 998

EP - 1007

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 8

ER -