Avaliação hemodinâmica durante exercício isotônico em pacientes submetidos a transplante cardíaco ortotópico / Hemodynamic Evalution During Isotonic Exercise of Patients Submitted to Orthotopic Heart Transpantation

ABSTRACT

PURPOSE--To evaluate the hemodynamic response of patients submitted to orthotopic heart transplantation during progressive isotonic exercise. METHODS--Eight patients who underwent orthotopic heart transplantation have been evaluated through invasive hemodynamic study during isotonic exercise. The mean right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP), arterial blood pressure (ABP), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), heart rate (HR) and cardiac output (CO) have been determined in three distinct situations at rest in the supine position (R), at rest with the legs up (RU) and during progressive isotonic exercise (E). The hemodynamic results at rest have been compared to the ones before transplantation. Phase RU and E results have been compared with each other. RESULTS--Comparing to the phase before transplantation at the R phase we found normalization of mean PAP (34.9 +/- 14.0 to 17.0 +/- 3.5 mmHg), RAP (7.3 +/- 4.3 to 2.9 +/- 1.9 mmHg) and CO (2.9 +/- 0.98 to 5.7 +/- 0.99 l/min), otherwise there was an increase in HR (89 +/- 15 to 94 +/- 13 bpm) mean ABP (84 +/- 25 to 115 +/- 12 mmH) and SVR (30 +/- 15 to 22 +/- 7 units Wood), (p < 0.05). Comparing phase E to phase RU, there was a significant increase in RAP (3.1 +/- 1.8 to 9.4 +/- 3.9 mmHg), mean PAP (21.0 +/- 2.8 to 37.0 +/- 10.0 mmHg), PAWP (8.1 +/- 2.1 to 15.0 +/- 5.8 mmHg), CO (5.8 +/- 0.8 to 9.9 +/- 2.4 l/min), HR (93 +/- 8 to 116 +/- 18 bpm) and a decrease in SVR (22.0 +/- 3.0 to 13.3 +/- 3.8 units Wood), (p < 0.05), otherwise there was no statistically significant modifications in PVR (2.2 +/- 0.7 to 2.3 +/- 1.2 units Wood) and mean ABP (129 +/- 12 to 129 +/- 15 mmHg), (p = NS). CONCLUSION--Patients submitted to heart transplantation may improve cardiac output mainly from increasing in stroke volume, associated with an increase in RAP and PAP. Nevertheless, the improvement increase in CO is compatible to exercise capacity after heart transplantation