IMPACT OF MEDICAL THERAPY ON PULMONARY-HYPERTENSION IN PATIENTS WITH CONGESTIVE-HEART-FAILURE AWAITING CARDIAC TRANSPLANTATION

Pulmonary artery (PA) hypertension in transplant recipients increases mortality from right heart failure following heart transplantation. We examined the impact of long-term medical therapy on the severity of P A hypertension in patients with end-stage congestive heart failure on a transplant waiting list. The initial and final, quarterly right hear t catheterization data on 60 patients (50 men, aged 50 +/- 9 years, Ne w York Heart Association class III to IV) awaiting heart transplantati on were analyzed and the patients divided into 2 groups: group A, thos e with persistent elevated systolic PA pressures throughout the 10-mon th follow-up (n = 31 of 60), and group B, those who had any decrease i n systolic PA pressure during that period (n = 29 of 60). Group A had no change in hemodynamics. Group B had a significant decrease (+/- SD) in right atrial (11 +/- 7 to 5 +/- 4 mm Hg), PA (57 +/- 11 to 37 +/- 11 mm Hg), and PA wedge (25 +/- 9 to 14 +/- 7 mm Hg) pressures, with i ncreases in cardiac output (3.8 +/- 0.9 to 4.7 +/- 1.1 L/min) and elec tion fraction (18 +/- 6% to 27 +/- 11%) (p <0.05). The combined end po int of transplant or death occurred in 28 of 31 patients (90%) in grou p A versus 14 of 29 (50%) in group B (p = 0.0004). Ischemic etiology w as present in 71% of patients in group A versus 68% with idiopathic di lated cardiomyopathy in group B (p = 0.003). The reversibility of PA h ypertension rather than its initial severity is predictive of patient clinical outcome. Idiopathic, as opposed to ischemic, cardiomyopathy r esponds better to medical therapy.