Association between routine measures of graft function and mortality in heart transplant recipients

ObjectiveTo date, long-term graft dysfunction, an important cause of death after heart transplantation, has been defined as a left ventricular ejection fraction (LVEF) of ≤40% or right atrial pressure (RAP) of ≥15 mm Hg. Empirical associations between measures of cardiac function and mortality post-transplant remain, however, unestablished.MethodsWe conducted a retrospective two-centre cohort study of consecutive adults who underwent heart transplant between 2002 and 2017. We evaluated the association between LVEF and RAP and mortality, including rejection and cardiac allograft vasculopathy as additional time-dependent covariates using Cox proportional hazard models. We applied restricted cubic splines to both LVEF and RAP.ResultsOf 590 eligible heart transplant recipients, of whom 72% were male with a mean age of 49 years, 410 received their transplant at Toronto General Hospital and 180 at Rigshospitalet. We observed a 5% absolute risk increase for 1-year mortality, from 11% to 16%, when the LVEF dropped to 53% (HR 1.71 for LVEF of 53% compared with 60%, 95% CI 1.36 to 2.14) or when the RAP increased to 12 mm Hg (HR 1.49 for RAP of 12 mm Hg compared with 5 mm Hg, 95% CI 1.04 to 2.13).ConclusionIn this study, we observed that small changes in graft function at any time post-transplant are associated with an increased mortality. Our results suggest that the current definition of graft dysfunction may underestimate patient risk of adverse outcomes.

Download Full-text

263: Beta-Blocker Therapy Improves Left Ventricular Ejection Fraction in Heart Transplant Recipients with Allograft Dysfunction

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.11.270 ◽

2009 ◽

Vol 28 (2) ◽

pp. S158 ◽

Cited By ~ 1

Author(s):

G. Poglajen ◽

M. Sebestjen ◽

R. Okrajsek ◽

F. Haddad ◽

B. Vrtovec

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Heart Transplant ◽

Beta Blocker ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Transplant Recipients ◽

Ventricular Ejection Fraction ◽

Blocker Therapy ◽

Heart Transplant Recipients

Download Full-text

Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type natriuretic peptide

Cardiology in the Young ◽

10.1017/s104795112100247x ◽

2021 ◽

pp. 1-8

Author(s):

Bethany L. Wisotzkey ◽

Bereketeab Haileselassie ◽

Neal Jorgensen ◽

Erin L. Albers ◽

Mariksa S. Kemna ◽

...

Keyword(s):

Heart Rate ◽

Natriuretic Peptide ◽

Heart Transplant ◽

Left Ventricular ◽

Right Atrial ◽

Z Score ◽

Transplant Recipients ◽

Pulmonary Capillary ◽

Echocardiographic Parameters ◽

Heart Transplant Recipients

Abstract Background: Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters. Methods: A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data. Results: Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e’, and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e’ were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index. Conclusions: B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.

Download Full-text

Determinants of sudden cardiac death after heart transplantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1110 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Bonnet ◽

G Coutance ◽

V Waldmann ◽

O Aubert ◽

A Asselin ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Sudden Death ◽

Incidence Rate ◽

Heart Transplant ◽

Cardiac Death ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

First Year ◽

Transplant Recipients ◽

Heart Transplant Recipients

Abstract Background Heart transplant recipients are at high-risk of sudden cardiac death (SCD). However, risk factors of SCD in heart recipients remained poorly described. Objective To assess the predictors of SCD beyond the first-year post-transplant. Methods We enrolled consecutive patients transplanted between 2004 and 2017 in two French referral centers. We excluded patients deceased during the first year. Patients underwent an evaluation at the day of transplantation and during the first year, comprising clinical, biological, histological, immunological (circulating anti-HLA DSA) and interventional (cardiac allograft vasculopathy assessment) parameters. Echocardiographies were routinely performed in all included patients according to a prespecified protocol. According to the last consensus, SCD was defined as an unexpected out-of-hospital cardiac arrest without obvious non-cardiac cause, in the first hour after initiation of symptoms. Cox model analysis was used to determine the parameters associated with sudden death risk. Results A total of 913 patients were included. The median follow-up post-HT was 5.9 years (IQR=2.9–8.5). Among the 213 deaths after one year, 44 patients (21%) died from SCD. In this population, the incidence rate of SCD was 0,82 per 100 person-year (95% CI: 0,51–2,05). Among the 60 parameters tested in univariate analysis, we identified 2 independent factors of sudden death after 1 year post-HT: left ventricular ejection fraction (LVEF) ≤55% any time after transplantation ( HR 4.07, 95% CI 1.94–8.53, p<0.001) and the presence of circulating anti-HLA DSA at the time of transplantation (HR 2.79, 95% CI 1.37–5.68, p=0.005). The incidence rate of SCD was 2.17 per 100 person-year (95% CI: 1.42; 4.60) and 1.21 per 100 person-year (95% CI: 0.80; 2.58) in patients with FEVG<55% (n=73) and in patients with pre-formed DSA (n=260), respectively. Conclusion In a large multicentric and highly phenotyped cohort of heart transplant recipients, we identified two independent factors associated with SCD beyond the first year. This study provides fresh evidence of SCD assessment for improving risk stratification of HT recipients. Funding Acknowledgement Type of funding source: None

Download Full-text

An Unusual Association: Right Atrial Myxoma and Severe Left Ventricular Dysfunction. Case Report and Review of the Literature

The Heart Surgery Forum ◽

10.1532/hsf98.2014420 ◽

2015 ◽

Vol 17 (6) ◽

pp. 285

Author(s):

Lucian Florin Dorobantu ◽

Ovidiu Chioncel ◽

Alexandra Pasare ◽

Dorin Lucian Usurelu ◽

Ioan Serban Bubenek-Turconi ◽

...

Keyword(s):

Ejection Fraction ◽

Ventricular Dysfunction ◽

Left Ventricular Systolic Dysfunction ◽

Left Ventricular ◽

Right Atrial ◽

Left Ventricular Ejection ◽

Cardiac Tumors ◽

Severe Left Ventricular Dysfunction ◽

Ventricular Ejection Fraction ◽

Increased Risk

Myxomas comprise 50% of all benign cardiac tumors in adults, with the right atrium as their second most frequent site of origin. Surgical resection is the only effective therapeutic option for patients with these tumors. The association between right atrial myxomas and severe left ventricular systolic dysfunction is extremely rare and makes treatment even more challenging. This was the case for our patient, a 47-year-old male with a right atrial mass and a severely impaired left ventricular function, with a 20% ejection fraction. Global enlargement of the heart was also noted, with moderate right ventricular dysfunction. The tumor was successfully excised using the on-pump beating heart technique, with an immediate postoperative improvement of the left ventricular ejection fraction to 35%. The technique proved useful, with no increased risk to the patient.

Download Full-text