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Elevated pulmonary vascular resistance is superior to mean transpulmonary gradient in predicting right heart failure after heart transplantation: a 12-year single center analysis

Session Poster Session 3

Speaker Christopher Strong

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Heart Transplantation
  • Session type : Poster Session

Authors : CMF Strong (Lisbon,PT), A Tralhao (Lisbon,PT), C Aguiar (Lisbon,PT), MJ Rebocho (Lisbon,PT), T Nolasco (Carnaxide,PT), M Marques (Carnaxide,PT), A Ventosa (Lisbon,PT), M Mendes (Lisbon,PT), M Abecasis (Carnaxide,PT), JP Neves (Carnaxide,PT)

Authors:
CMF Strong1 , A Tralhao1 , C Aguiar1 , MJ Rebocho1 , T Nolasco2 , M Marques2 , A Ventosa1 , M Mendes1 , M Abecasis2 , JP Neves2 , 1Hospital de Santa Cruz, Cardiology - Lisbon - Portugal , 2Hospital de Santa Cruz - Lisbon - Portugal ,

Citation:

Background

Right heart failure (RHF) after heart transplantation (HTx) may adversely affect prognosis. Risk prediction is mostly based on invasive hemodynamic data but there is no consensus about the single best parameter to aid in risk stratification.

Purpose

We sought to compare the ability of usual right heart catheterization (RHC) derived parameters in predicting RHF after HTx.

Methods

Single-center retrospective study of all adult patients undergoing orthotopic bicaval HTx between January 2006 and November 2017 in a single-center. Pulmonary artery (PA) pressures (mean [mPAP], diastolic [dPAP]), transpulmonary gradients (mean [mTPG], diastolic [dTPG]) and pulmonary vascular resistance (PVR) were obtained from each patient’s last RHC before HTx. RHF after HTx was defined as right ventricular dilatation (right ventricle/left ventricle basal diameter > 1) and dysfunction (tricuspid annular systolic plane excursion < 12 mm) on transthoracic echocardiography plus signs of end-organ dysfunction (creatinin increase > 0.5 mg/dL from baseline or spontaneous prothrombin time > 14 s), without a plausible alternative cause. Univariate and multivariate analysis were performed to find independent predictors of RHF and receiver operating curve (ROC) analysis was used to assess discriminative power.

Results

Fifty-eight heart transplant patients were identified and analyzed (mean age 51±11 years, 58 % male). The most frequent etiologies were ischemic heart disease (n = 21) and dilated idiopathic cardiomyopathy (n=16).  Pre-operative PVR was 3.3±2.1 Wood units, mean PAP was 38±10 mmHg, dPAP was 27±7 mmHg and mTPG and dTPG were 10±5.3 and 3.5±2.7 mmHg, respectively. 14% of patients (n=8) were on inotropic support and 10% (n=6) required pre-HTx mechanical circulatory support (MCS). After HTx, RHF incidence was 5.2 % (n=3) and one patient required temporary right ventricular MCS. In univariate analysis, elevated PVR, mTPG, mPAP and dPAP were associated with increased incidence of RHF. After multivariate logistic regression modelling, only PVR remained significantly associated with post-HTx RHF (OR 1.6 [CI 95%, 1.1-2.6], p=0.03). ROC curve analysis using PVR as the discriminator yielded a C-statistic of 0.8 [CI 95%, 0.7-1.0, p=0.03) for RHF occurrence after HTx. In a mean follow-up of 4.2 years, overall mortality was not different between those with RHF and those without (p=1.0).

Conclusions

In our population, RHF after HTx was an uncommon finding. Elevated PVR seems to be superior to other RHC derived parameters in predicting RHF following HTx.

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