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

TL;DR

This study shows that certain heart function measures in heart transplant patients are linked to worse long-term survival, even if their heart function seems normal.

Contribution

The study identifies Ea and Ees as independent predictors of mortality in heart transplant patients with normal LVEF.

Findings

Arterial elastance (Ea) and left ventricular end-systolic elastance (Ees) were significantly higher in heart transplant recipients compared to healthy controls.

High Ea and low Ees were independently associated with increased mortality risk in heart transplant patients.

Ventricular arterial coupling (VAC) did not significantly predict cardiovascular mortality in this patient group.

Abstract

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/m2 and Ees ≤ 6.75 mmHg/mL/m2, and both were independently associated with mortality risk after adjustment (Ea > 4 mmHg/mL/m2: HR 2.25 [95% CI 1.38–3.66], p = 0.013; Ees ≤ 6.75 mmHg/mL/m2: 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.

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