Prognosis of medically treated patients referred for cardiac transplantation.

Objectives: To assess prognosis and factors influencing survival of transplant candidates in whom continued medial therapy was recommended in comparison to that of immediately listed patients.

Methods: Retrospective analysis of clinical, echocardiographic and hemodynamic data as related to survival or listing for transplantation of medically treated transplant candidates.

Patients: 160 patients considered 'too well' for cardiac transplantation and 133 patients immediately listed for transplantation.

Results: Forty-one of the medically treated patients deteriorated clinically and were listed after 10.7+/-12.3 months after initial evaluation. Mid-term prognosis (2 years) of patients never listed was comparable to that of immediately listed patients (74% vs. 70%) but long-term prognosis (5 years) was worse (41% vs. 54%, p<0.001). Cardiothoracic ratio and pulmonary capillary wedge pressure were independent predictors of survival (multivariate analysis) in patients whose NYHA class and physical working capacity improved and cardiothoracic ratio decreased significantly after adjustment of medical therapy.

Conclusions: Mid-term prognosis of selected patients considered 'too well' for transplantation is comparable to patients immediately listed. Lower left ventricular filling pressures, smaller hearts on chest X-ray on initial evaluation, and improvement of symptoms during follow up may identify a subgroup of patients who do well on optimized therapy.