Impact of post-transplant diabetes on left ventricular function following heart transplantation

Orthotopic heart transplantation (OHT) is an end-stage treatment option for heart failure (HF). Although post-transplant diabetes (PTDM) is a well-described complication following immunosuppressive treatment, the impact on LV function post-OHT has not been evaluated. The purpose of this study was to analyse the influence of PTDM on LV function in OHT patients using conventional and speckle tracking echocardiography. Furthermore, we aimed to compare echocardiographic LV function parameters to HbA1c levels in OHT recipients with or without PTDM.

The study included 104 (n=77 male, mean age 51±15 years) consecutive OHT patients (PTDM n=36) examined at their routine 3-year follow-up. Blood pressure, heart rate, and HbA1c levels were recorded in conjunction with the echocardiographic examination.

Participants with PTDM demonstrated impaired LV function measured by global longitudinal strain (p=0.002). Patients with PTDM also revealed increased septum diameter (p=0.008), and a lower diastolic EA-ratio (p=0.04) compared to the non-PTDM patients. A weak correlation between high HbA1c levels and poor LVGLS was detected (r=0.30, p<0.05). No correlation was found when comparing echocardiographic parameters to blood pressure and heart rate.

A subtle LV dysfunction, including remodelling of the heart (i.e., increased wall thickness), reduced longitudinal contractile function, and altered diastolic function, was present in OHT patients with PTDM. Our findings suggest that sub-clinical myocardial dysfunction is present in OHT patients with PTDM and may progress to clinical LV dysfunction and HF. Hence, analysing secondary cardiac effects of PTDM in OHT patients may have a therapeutic and prognostic value and could potentially influence long-term patient survival.

Type of funding sources: None.