Impact of Left Ventricular-Vascular Interaction on Long-Term Outcome After Heart Transplantation.

BACKGROUND AND AIM

To compare pressure-volume (PV) derivative variables between HT patients and healthy controls and to assess their impact on long-term outcome.

METHODS

In this single-center retrospective study, HT patients surviving their first post-HT year with left ventricular ejection fraction (LVEF) ≥50%, absence of allograft vasculopathy, and rejection were enrolled. PV variable surrogates were measured by transthoracic echocardiography and compared with healthy controls. The endpoint was cardiovascular mortality.

RESULTS

From 1985 to 2015, 345 patients were enrolled. Arterial elastance (Ea) and left ventricular end-systolic elastance (Ees) were higher in HT recipients than in healthy controls (4.03 vs. 1.65, p < 0.0001 and 6.75 vs. 2.47, p < 0.0001, respectively), while ventricular arterial coupling (VAC) was similar between the two groups (0.66 vs. 0.59, p = 0.105). After a median of 11.3-year follow-up, 59 (17%) HT recipients died. VAC was not significantly associated with cardiac mortality (p = 0.074). Survival was lower in HT recipients with Ea > 4 mmHg/mL/m and Ees ≤ 6.75 mmHg/mL/m, and both were independently associated with mortality risk after adjustment (Ea > 4 mmHg/mL/m: HR 2.25 [95% CI 1.38-3.66], p = 0.013; Ees ≤ 6.75 mmHg/mL/m: HR 3.70 [95% CI 1.95-7.06], p = 0.001).

CONCLUSIONS

In HT recipients surviving the first year after transplantation with normal LVEF, high Ea, and low Ees values were independently associated with poorer outcomes in long-term follow-up.