Mattia Corianò, Nicola Pradegan, Andrea Golfetto, Vincenzo Tarzia, Annalisa Angelini, Antonio Gambino, Chiara Tessari, Marny Fedrigo, Giuseppe Toscano, Gino Gerosa, Francesco Tona
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The endpoint was cardiovascular mortality.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>p</i> < 0.0001 and 6.75 vs. 2.47, <i>p</i> < 0.0001, respectively), while ventricular arterial coupling (VAC) was similar between the two groups (0.66 vs. 0.59, <i>p</i> = 0.105). After a median of 11.3-year follow-up, 59 (17%) HT recipients died. VAC was not significantly associated with cardiac mortality (<i>p</i> = 0.074). Survival was lower in HT recipients with Ea > 4 mmHg/mL/m<sup>2</sup> and Ees ≤ 6.75 mmHg/mL/m<sup>2</sup>, and both were independently associated with mortality risk after adjustment (Ea > 4 mmHg/mL/m<sup>2</sup>: HR 2.25 [95% CI 1.38–3.66], <i>p</i> = 0.013; Ees ≤ 6.75 mmHg/mL/m<sup>2</sup>: HR 3.70 [95% CI 1.95–7.06], <i>p</i> = 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70178","citationCount":"0","resultStr":"{\"title\":\"Impact of Left Ventricular-Vascular Interaction on Long-Term Outcome After Heart Transplantation\",\"authors\":\"Mattia Corianò, Nicola Pradegan, Andrea Golfetto, Vincenzo Tarzia, Annalisa Angelini, Antonio Gambino, Chiara Tessari, Marny Fedrigo, Giuseppe Toscano, Gino Gerosa, Francesco Tona\",\"doi\":\"10.1111/ctr.70178\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and aim</h3>\\n \\n <p>To compare pressure-volume (PV) derivative variables between HT patients and healthy controls and to assess their impact on long-term outcome.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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, <i>p</i> < 0.0001 and 6.75 vs. 2.47, <i>p</i> < 0.0001, respectively), while ventricular arterial coupling (VAC) was similar between the two groups (0.66 vs. 0.59, <i>p</i> = 0.105). After a median of 11.3-year follow-up, 59 (17%) HT recipients died. VAC was not significantly associated with cardiac mortality (<i>p</i> = 0.074). 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引用次数: 0
摘要
背景和目的比较HT患者与健康对照者之间的压力-体积（PV）衍生变量，并评估其对长期预后的影响。方法在这项单中心回顾性研究中，纳入了左心室射血分数(LVEF)≥50%、没有同种异体移植血管病变和排斥反应的HT患者。通过经胸超声心动图测量PV变量替代物，并与健康对照进行比较。终点是心血管死亡率。结果1985 - 2015年共纳入345例患者。接受HT治疗的患者动脉弹性（Ea）和左心室收缩末期弹性（Ees）高于健康对照组(4.03 vs. 1.65, p <；0.0001和6.75 vs. 2.47, p <；（分别为0.0001），而两组间心室动脉耦合（VAC）相似（0.66 vs. 0.59, p = 0.105）。中位随访11.3年后，59例（17%）HT受者死亡。VAC与心脏死亡率无显著相关性（p = 0.074）。合并Ea和gt的HT患者生存率较低；4 mmHg/mL/m2和Ees≤6.75 mmHg/mL/m2，两者均与调整后的死亡风险独立相关(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)。结论在LVEF正常的移植后存活1年的受体患者中，高Ea值和低Ees值与长期随访预后较差独立相关。
Impact of Left Ventricular-Vascular Interaction on Long-Term Outcome After Heart Transplantation
Background and aim
To compare pressure-volume (PV) derivative variables between HT patients and healthy controls and to assess their impact on long-term outcome.
Methods
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.
Results
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).
Conclusions
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.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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