Severe right ventricular dysfunction is an independent predictor of pre- and post-transplant mortality among candidates for heart transplantation

Autor: Dominique Grisoli, Vlad Gariboldi, Eleonore Ravis, Alexis Theron, Pierre Morera, Nicolas Jaussaud, Julien Mancini, Catherine Guidon, Alberto Riberi, Virginie Chalvignac, Gilbert Habib, Annick Mouly-Bandini, Frederic Collart
Přispěvatelé: Génétique Médicale et Génomique Fonctionnelle (GMGF), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Centre National de la Recherche Scientifique (CNRS), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] (BiosTIC ), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de Chimie de la Matière Condensée de Bordeaux (ICMCB), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut Polytechnique de Bordeaux-Université de Bordeaux (UB), Dysoxie, suractivité : aspects cellulaires et intégratifs thérapeutiques (DS-ACI / UMR MD2), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université (AMU), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Cardiaque Adultes, Assistance Publique - Hôpitaux de Marseille (APHM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Chirurgie Cardiaque [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), COMBE, Isabelle
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Waiting Lists
medicine.medical_treatment
Ventricular Dysfunction
Right
Hemodynamics
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
030230 surgery
Independent predictor
Risk Assessment
Severity of Illness Index
03 medical and health sciences
0302 clinical medicine
Risk Factors
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Internal medicine
medicine
Odds Ratio
Humans
Survival rate
Proportional Hazards Models
Retrospective Studies
Heart transplantation
Heart Failure
business.industry
Mortality rate
Age Factors
General Medicine
Middle Aged
medicine.disease
Right ventricular dysfunction
Tissue Donors
3. Good health
Surgery
Transplantation
Treatment Outcome
Heart failure
Multivariate Analysis
[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Cardiology
Ventricular Function
Right
Heart Transplantation
Female
France
Cardiology and Cardiovascular Medicine
business
Zdroj: Archives of cardiovascular diseases
Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2017, 110 (3), pp.139-148. ⟨10.1016/j.acvd.2016.06.002⟩
Archives of cardiovascular diseases, 2017, 110 (3), pp.139-148. ⟨10.1016/j.acvd.2016.06.002⟩
ISSN: 1875-2136
1875-2128
DOI: 10.1016/j.acvd.2016.06.002⟩
Popis: International audience; Background. Heart transplantation is the gold-standard treatment for end-stage heart failure. However, the shortage of grafts has led to longer waiting times and increased mortality for candidates without priority. Aims. To study waiting-list and post-transplant mortality, and their risk factors among patients registered for heart transplantation without initial high emergency procedure. Methods. All patients registered on the heart transplantation waiting list (2004-2015) without initial high emergency procedure were included. Clinical, biological, echocardiographic and haemodynamic data were collected. Waiting list and 1-year post-transplant survival were analysed with a Kaplan-Meier model. Results. Of 221 patients enrolled, 168 (76.0%) were men. Mean age was 50.0 +/- 12.0 years. Forty-seven patients died on the waiting list, resulting in mortality rates of 11.2 +/- 2.7% at 1 year, 31.9 +/- 5.4% at 2 years and 49.4 +/- 7.1% at 3 years. Median survival was 36.0 +/- 4.6 months. In the multivariable analysis, left ventricular ejection fraction < 30% (hazard ratio [HR]: 3.76, 95% confidence interval [CI]: 1.38-10.24; P=0.010) and severe right ventricular systolic dysfunction (HR: 2.89, 95% CI: 1.41-5.92; P=0.004) were associated with increased waiting-list mortality. The post-transplant survival rate was 73.1 +/- 4.4% at 1 year. Pretransplant severe right ventricular dysfunction and age > 50 years were strong predictors of death after transplantation (HR: 5.38, 95% CI: 1.38-10.24 [P=0.020] and HR: 6.16, 95% CI: 1.62-9.32 [P=0.0130], respectively). Conclusions. Mortality among candidates for heart transplantation remains high. Patients at highest risk of waiting-list mortality have to be promoted, but without compromising post transplant outcomes. For this reason, candidates with severe right ventricular dysfunction are of concern, because, for them, transplantation is hazardous. (C) 2016 Elsevier Masson SAS. All rights reserved.
Databáze: OpenAIRE
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