Am. J. Respir. Crit. Care Med.,
Volume 158, Number 5, November 1998, 1396-1402
Limitations of Radionuclide Angiographic
Assessment of Left Ventricular Systolic
Function before Lung Transplantation
HERVÉ
MAL,
ANTOINE
LEVY,
THIERRY
LAPERCHE,
CHARLES
SLEIMAN,
JEAN LOUIS
STIEVENART,
ALAIN
COHEN-SOLAL,
OLIVIER
BRUGIÈRE,
GUY
LESÈCHE,
GILLES
JEBRAK,
and
MICHEL
FOURNIER
Services de Pneumologie et Réanimation Respiratoire, Cardiologie, Chirurgie Thoracique et Vasculaire, and Médecine Nucléaire,
Hôpital Beaujon, Clichy, France
To evaluate the influence of increased right ventricular afterload on radionuclide assessment of the
left ventricular ejection fraction (LVEF), we compared the preoperative and postoperative value of
isotopic LVEF in 11 patients who underwent lung transplantation and had a preoperative LVEF value
below 55% (normal value: 68 ± 8%). The underlying disease conditions were obstructive lung disease (n = 7) and pulmonary fibrosis (n = 4). The transplantation procedure was unilateral in 10 patients and bilateral in one. The mean value of isotopic LVEF prior to transplantation was 51 ± 3%
(range: 49% to 55%). At 42 ± 13 mo postoperatively, isotopic LVEF increased significantly, to 65 ± 10% (p = 0.001), suggesting that intrinsic left ventricular systolic function was in fact normal in these
patients. We hypothesize that the low preoperative isotopic LEVF was not related to intrinsic dysfunction of the left ventricle, but rather to right ventricular pressure overload, leading to bulging of
the interventricular septum into the left ventricle and to subsequent geometric distortion of the left
ventricle. We conclude that isotopic LVEF may underestimate intrinsic left-ventricular systolic function in patients with severe chronic lung disease. Candidates for lung transplantation should not be
rejected on the basis of a low isotopic LVEF, provided echocardiographic examination does show apparently normal left ventricular contraction.
