Prognostic value of cardiac CT-derived RV dysfunction in lung transplantation candidates: A single-center retrospective study.

Abstract

Background: There are no specific criteria for listing and prioritizing lung transplantation (LTx) candidates based on the severity of right ventricular (RV) dysfunction. We evaluated the prognostic value of cardiac CT-derived right ventricular ejection fraction (RVEF) in LTx candidates.

Methods: This retrospective study included patients who were listed for LTx and underwent cardiac computed tomography (CT) between September 2019 and December 2023. Patients were categorized into 3 groups based on CT-derived RVEF and survival analyses were performed among these groups: normal RVEF (≥45%), mild-to-moderate RV dysfunction (25%-45%), and severe RV dysfunction (<25%).

Results: In the 203 patients (median age, 61 years [interquartile range [IQR], 54-64]), the most common indication for LTx was interstitial lung disease (79.3%). Patients were followed for a median duration of 297 days (IQR, 140-632), and the 1-year survival rates were 85.2% for those with normal RV, 69.3% for those with mild-to-moderate RV dysfunction, and 55.6% for those with severe RV dysfunction (p < 0.001). Severe RV dysfunction (hazard ratio [HR] 6.72, p = 0.020), age (HR 1.1, p = 0.010), and 6-minute walking distance (HR 0.62, p = 0.010) were associated with an increased risk of 1-year mortality.

Conclusions: Severe RV dysfunction identified on cardiac CT was a significant prognostic factor for 1-year mortality in LTx candidates. Patients with severe RV dysfunction should be prioritized for LTx and classified as urgent due to their elevated short-term mortality risk. Cardiac CT may provide valuable prognostic information during the pretransplant evaluation process.