Cardiac allograft hypertrophy is associated with impaired exercise tolerance after heart transplantation

Eugenia Raichlin, Malik A. Al-Omari, Courtney L. Hayes, Brooks S. Edwards, Robert P. Frantz, Barry A. Boilson, Alfredo L. Clavell, Richard J. Rodeheffer, John A. Schirger, Sudhir S. Kushwaha, Thomas G. Allison, Naveen L. Pereira

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Exercise performance, an important aspect of quality of life, remains limited after heart transplantation (HTx). This study examines the effect of cardiac allograft remodeling on functional capacity after HTx. Methods: The total cohort of 117 HTx recipients, based on echocardiographic determination of left ventricle mass and relative wall thickness at 1 year after HTx, was divided into 3 groups: (1) NG, normal geometry; (2) CR, concentric remodeling; and (3) CH, concentric hypertrophy. Cardiopulmonary exercise testing was performed 5.03 ± 3.08 years after HTx in all patients. Patients with acute rejection or significant graft vasculopathy were excluded. Results: At 1 year post-HTx, 30% of patients had CH, 55% had CR and 15% had NG. Exercise tolerance, measured by maximum achieved metabolic equivalents (4.62 ± 1.44 vs 5.52 ± 0.96 kcal/kg/h), normalized peak Vo 2 (52 ± 14% vs 63 ± 12%) and Ve/Vco 2 (41 ± 17 vs 34 ± 6), was impaired in the CH group compared with the NG group. A peak Vo 2 ≤14 ml/kg/min was found in 6%, 22% and 48% of patients in the NG, CR and CH groups, respectively (p = 0.01). The CH pattern was associated with a 7.4-fold increase in relative risk for a peak Vo 2 ≤14 ml/kg/min compared with NG patients (95% confidence interval 1.1 to 51.9, p = 0.001). After multivariate analysis, a 1-year CH pattern was independently associated with a reduced normalized peak Vo 2 (p = 0.018) and an elevated Ve/Vco 2 (p = 0.035). Conclusions: The presence of CH at 1 year after HTx is independently associated with decreased normalized peak Vo 2 and increased ventilatory response in stable heart transplant recipients. The identification of CH, a potentially reversible mechanism of impairment in exercise capacity after HTx, may have major clinical implications.

Original languageEnglish (US)
Pages (from-to)1153-1160
Number of pages8
JournalJournal of Heart and Lung Transplantation
Issue number10
StatePublished - Oct 2011


  • cardiac allograft remodeling
  • exercise intolerance
  • exercise physiology
  • heart transplantation
  • left ventricular hypertrophy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation


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