Corianò Mattia, Pradegan Nicola, Golfetto Andrea, Tarzia Vincenzo, Angelini Annalisa, Gambino Antonio, Tessari Chiara, Fedrigo Marny, Toscano Giuseppe, Gerosa Gino, Tona Francesco
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital Padua, Padua, Italy.
Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
Clin Transplant. 2025 May;39(5):e70178. doi: 10.1111/ctr.70178.
To compare pressure-volume (PV) derivative variables between HT patients and healthy controls and to assess their impact on long-term outcome.
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.
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).
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.
比较心脏移植（HT）患者与健康对照者的压力-容积（PV）衍生变量，并评估它们对长期预后的影响。
在这项单中心回顾性研究中，纳入了心脏移植术后第一年存活、左心室射血分数（LVEF）≥50%、无移植血管病变且无排斥反应的HT患者。通过经胸超声心动图测量PV变量替代指标，并与健康对照者进行比较。终点为心血管死亡率。
1985年至2015年，共纳入345例患者。HT受者的动脉弹性（Ea）和左心室收缩末期弹性（Ees）高于健康对照者（分别为4.03对1.65，p<0.0001；6.75对2.47，p<0.0001），而两组间的心室动脉耦联（VAC）相似（0.66对0.59，p=0.105）。中位随访11.3年后，59例（17%）HT受者死亡。VAC与心脏死亡率无显著相关性（p=0.074）。Ea>4 mmHg/mL/m且Ees≤6.75 mmHg/mL/m的HT受者生存率较低，调整后两者均与死亡风险独立相关（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）。
在移植后第一年存活、LVEF正常的HT受者中，高Ea和低Ees值与长期随访中较差的预后独立相关。
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