Long-term function of human cardiac allografts assessed by two-dimensional echocardiography

Previous studies from our laboratory demonstrated increasing left ventricular mass in cyclosporine-treated cardiac allograft recipients over 30 days after transplantation, but the long-term evolution of this process and possible effects on allograft function are unknown. Accordingly, quantitative two-dimensional echocardiography was performed 2 and 23 days and 15 months postoperatively in 14 recipients treated with cyclosporine and prednisone. Changes in left ventricular ejection fraction, end-diastolic volume, mass, and end-systolic wall stress were analyzed. Comparison of studies at 2 and 23 days revealed significant (p < 0.01) increases in ejection fraction (54% ± 8% [standard deviation] to 62% ± 4%), end-diastolic volume (84% ± 32 ml to 96 ± 31 ml), and left ventricular mass (118 ± 45 gm to 136 ± 41 gm). Comparison of studies at 23 days and 15 months revealed no significant change in end-diastolic volume or left ventricular mass, whereas ejection fraction decreased slightly (62% ± 4% to 57% ± 4%, p < 0.01). End-systolic wall stress decreased when data at 2 days and 15 months were compared (83 ± 24 gm/cm² versus 66 ± 18 gm/cm², p < 0.05), but no change in contractility was apparent from the ejection fraction/end-systolic stress relation. We conclude that left ventricular mass and end-diastolic volume increase early after transplantation in cyclosporine-treated cardiac allograft recipients, but these changes are not predictive of long-term results, which are characterized by no significant late variation in left ventricular mass, end-diastolic volume, or contractility.