End-Stage Diastolic and Systolic Heart Failure: Evaluation and Timing of Heart Transplantation

  • Eric D. PopjesEmail author
  • Anjali Tiku Owens
  • Mariell Jessup


End stage hypertrophic cardiomyopathy occurs in an estimated 3–15 % of patients and can present as either systolic or diastolic dysfunction. Risk factors for developing end stage disease include a family history of end stage disease, younger age at initial diagnosis, increased wall thickness and persistent arrhythmia. The classic form of adverse remodeling includes left ventricular cavity dilation with regression of hypertrophy and decrease in ejection fraction. Standard medical therapy for systolic heart failure and consideration of prophylactic defibrillator is indicated when LVEF is less than 50 %. Heart transplant is a viable option for patients with end stage hypertrophic cardiomyopathy, including those with systolic heart failure, diastolic heart failure or refractory arrhythmia. Strategies used to bridge patients to transplant include continuous inotropic infusion, left ventricular assist device, intra-aortic balloon pump, and in rare cases extracorporeal membrane oxygenation. Survival after heart transplant for hypertrophic cardiomyopathy is equal to or better than survival for patients who have other types of cardiomyopathies.

Key Words

Congestive heart failure End-stage HCM LV systolic dysfunction LV Diastolic dysfunction Restrictive physiology Left ventricular assist device (LVAD) Heart transplantation 


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Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Eric D. Popjes
    • 1
    Email author
  • Anjali Tiku Owens
    • 2
    • 3
  • Mariell Jessup
    • 3
  1. 1.Heart and Vascular InstitutePenn State Hershey Medical CenterHersheyUSA
  2. 2.Hospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Cardiovascular Medicine Division, Department of MedicineHospital of the University of Pennsylvania, University of Pennsylvania Perelman School of MedicinePhiladelphiaUSA

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