EFFECT OF HEART-TRANSPLANTATION ON IMPAIRED PERIPHERAL MICROVASCULAR PERFUSION AND REACTIVITY IN CONGESTIVE-HEART-FAILURE

Whether reduced peripheral blood flow in congestive heart failure is r eversed after heart transplantation, has not been closely examined. We therefore studied skin microvascular resting perfusion and reactivity in patients pre- and postoperatively. Resting digital skin perfusion, together with the responses to cold presser test, postocclusive react ive hyperemia and direct skin heating were examined with laser Doppler perfusion measurements. We examined 28 patients with congestive heart failure and 14 of these patients after heart transplantation and comp ared them to 13 healthy controls. Measurements were performed within 3 months preoperatively and 12 days, 1, 2, 3 and 6 months postoperative ly. Patients with congestive heart failure had significantly lower res ting perfusion levels than controls and demonstrated attenuated respon ses to both stimuli of vasodilation (all P<0.01). While peak hyperemic responses improved significantly after transplantation, postocclusive area under the hyperemic curve decreased further, and none of these v ariables were normalized after 6 months. In contrast, minimal perfusio n during cold presser test increased from a significantly lower level in the patients with congestive heart failure (P<0.05), to a level sim ilar to that of the controls within 12 days postoperatively. Thus, ski n microvascular perfusion and reactivity improve, but are not normaliz ed within 6 months of transplantation. Both pre- and postoperative fac tors may be involved in maintaining a dysfunction of the peripheral mi crocirculation, which may contribute to exercise intolerance and hyper tension in heart transplant recipients. (C) 1998 Elsevier Science Irel and Ltd.