ASSESSING RISK BY HEMODYNAMIC PROFILE IN PATIENTS AWAITING CARDIAC TRANSPLANTATION

A profile of hemodynamic abnormalities in patients listed for cardiac transplantation was related to survival during the first year after listing. After a patient is listed for cardiac transplantation, the waiting period for a suitable donor heart is of ten long therefore, objective criteria to determine risk would be helpful in identifying the group at highest risk of dying before receiving a transplant. Several studies have suggested certain hemodynamic parameters to be! related to a poor prognosis. However, no 1 variable has emerged as an adequate predictor of survival in patients awaiting cardiac transplantation. One-year outcomes were examined in 138 consecutive patients listed for cardiac transplantation, who were grouped according to a hemodynamic risk score (HRS) based on abnormalities in baseline measures of right atrial pressure, pulmonary artery systolic pressure transpulmonary gradient, cardiac: output, cardiac index and pulmonary vascular resistance. Right atrial pressure alone was the most significant predictor of survival (p < 0.05). Patients with a right atrial pressure > 12 mm Hg had a 47% 1-year survival as compared with the 68% survival for those with a right atrial pressure < 12 mm Hg. HRS was the next strongest predictor of survival. The 66% survival in group I (HRS = 0) and the 69% survival in group II (HRS = 1 to 3) were significantly (p < 0.03) higher than the 41% survival in group III (HRS = 4 to 6) at 1 year after listing. Differences in survival for the HRS groups could not be explained by left ventricular ejection fraction, left ventricular end-diastolic diameter or status at listing. When multivariate analyses were performed, only right atrial pressure (p < 0.05) and HRS (0 < 0.1) were significant predictors of survival. Contrary to the original hypothesis, the strongest predictor of survival was an individual hemodynamic parameter, i.e., right atrial pressure. A profile of hemodynamics represented by HRS was also a significant predictor of survival. Hemodynamic measures provide a useful means of risk stratifying patients on the cardiac transplantation waiting list.