PURPOSE: Secondary pulmonary hypertension resulting from severe parenchymal or airway diseases causing Cor Pulmonale (CP) is not uncommon among patients (pts) referred for lung transplantation (LUT). Right ventricular enlargement (RVE) or dysfunction (RVD) are pathologic manifestations of CP that can be detected and quantitated by echocardiography. How common is this entity and its impact on post-LUT outcomes has not been well detailed. We sought to determine the prevalence of preoperative CP by echo on LUT recipients (LUTR). Also, we desired to quantitate the impact of preoperative CP on clinical outcomes in LUTR.
METHODS: We reviewed our database of 206 adult LUTR from 1/1991 to 6/2005. Thirty-two LUTR underwent pre-LUT MUGA instead of echo and were excluded as were 3 redo-LUTR. RVE was measured in parasternal long axis and allocated to 2 groups (no RVE vs RVE). RVD was obtained from multiple views and graded subjectively by visual estimation. RVD findings were allocated to one of 4 groups: none, mild, moderate & severe. Groups were analysed as 2 groups(RVD yes or no) and by 4 as above. Clinical outcomes included all-cause mortality and post-LUT hospital length of stay (HLOS).
RESULTS: No significant differences existed between groups regarding gender, race, BMI, CAD, HTN, smoking, diabetes, cystic fibrosis or LVEF. CP was associated with age(OR 1.04, p=0.039), COPD(OR 1.13, p=0.041) and IPF(OR 1.21, p=0.025). Prevalence of total RVE was 22%, (severe 0%) and total RVD was 15% (severe 2%). HLOS was 9.7 days +/- 2.6 in non-CP group and 10.4 +/- 3.5 in CP group (p=0.39). One and 5 year survival (by Kaplan Meier) was similar between groups (p=NS by log rank).
CONCLUSION: The presence of preoperative CP by echo is associated with age, COPD, IPF but not cystic fibrosis or CAD. Although preoperative CP was common, severe CP was rare, which may reflect a selection bias. Preoperative CP was not associated with increased HLOS or death.
CLINICAL IMPLICATIONS: The presence of preoperative CP by echo should not solely affect one's candidacy for LUT.
DISCLOSURE: Lee Arcement, No Financial Disclosure Information; No Product/Research Disclosure Information