Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

Rivinius, Rasmus; Helmschrott, Matthias; Ruhparwar, Arjang; Schmack, Bastian; Darche, Fabrice F.; Thomas, Dierk; Bruckner, Tom; Doesch, Andreas O.; Katus, Hugo A.; Ehlermann, Philipp

doi:10.1002/ehf2.12549

Cited by 21 publications

(61 citation statements)

References 45 publications

(211 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They have showed worse 30-day mortality after HTx in patients with PAH, which was confirmed in our trial. Their multivariant analysis pointed out PAH as an independent negative predictor of early mortality with the HR: 4.4, 95% CI: 2.5-7.6, P < .01, also confirmed in our trial with HR: 0.279 (95% [CI]: 0.086-0.910; P = .034) [Rivinius 2020]. After the subanalysis, after 30 days postoperatively, the long-term survival in our trial remained the same for the two groups.…”

Section: Discussionsupporting

confidence: 84%

Pulmonary Artery Hypertension as A Risk Factor for Long-Term Survival after Heart Transplantation

Matković¹,

Milicevic²,

Bilbija³

et al. 2021

HSF

View full text Add to dashboard Cite

Background: Heart failure is the most frequent cause of pulmonary artery hypertension (PAH) and its severity may predict the development of heart failure (HF) and is known to be a prognostic factor of poor outcome after heart transplant (HTx). The aim of this study was to investigate the impact of preoperative PAH related to left-sided HF on long-term survival after HTx and to identify the hemodynamic parameters of PAH that predict survival after HTx. Methods: A prospective observational trial was performed, and it included 44 patients subjected to heart transplantation. Patients were divided into two groups: The first one with the preoperative diagnosis of PAH and the second one without the PAH diagnosed prior to the HTx. The two groups were compared for baseline characteristics, operative characteristics, survival, and hemodynamic parameters obtained by right heart catheterization. Survival was analyzed using Kaplan Meyer analysis, and Cox regression analysis was performed to determine independent predictors of survival. Results: The median follow-up time was 637.4 days (1-2028 days). The median survival within the group of patients with preoperative PAH was 1144 days (95% CI 662.884-1625.116) and 1918.920 days (95% CI 1594.577-2243.263) within the group of patients without PAH (P = .023), HR 0.279 (95% [CI]: 0.086-0.910; P = .034. The 30-day mortality in patients within PAH group was significantly higher, six versus two patients in the non PAH group (χ2 = 5.103, P < .05), while the long-term outcome after this period did not differ between the groups. Patients with preoperative PAH had significantly higher values of MPAP, PCWP, TPG and PVRI, while CO and CI did not differ between the two groups. Mean PVRI was 359.1 ± 97.3 dyn·s·cm-5 in the group with preoperative PAH and 232.2 ± 22.75 dyn·s·cm-5 in the group without PAH, P < .001. TPG values were 11.95 ± 5.08 mmHg in the PAH group while patients without PAH had mean values of 5.16 ± 1.97 mmHg, P < .001. Cox regression analysis was done for the aforementioned parameters. Hazard ratio for worse survival after HTx for elevated values of PVRI was 1.006 (95% [CI]: 1.001-1.012; P = .018) TPG had a hazard ratio of 1.172 (95% [CI]: 1.032-1.233; P = .015). Conclusion: Pulmonary artery hypertension is an independent risk factor for higher 30-day mortality after HTx, while it does not affect the long-term outcome. Hemodynamic parameters obtained by right heart catheterization in heart transplant candidates could predict postoperative outcome. PVRI and TPG have been identified as independent predictors of higher 30-day postoperative mortality.

show abstract

Section: Discussionsupporting

confidence: 84%

Pulmonary Artery Hypertension as A Risk Factor for Long-Term Survival after Heart Transplantation

Matković¹,

Milicevic²,

Bilbija³

et al. 2021

HSF

View full text Add to dashboard Cite

show abstract

“…According to the ethical approval, no additional written informed consent was required for this observational study as only data of the clinical routine were used. 4,15,16,[24][25][26] Our study included all adult patients (≥ 18 years) who received first HTX at Heidelberg Heart Center, Heidelberg, Germany, between 1989 and 2019. Patients with a second HTX were not included.…”

Section: Patientsmentioning

confidence: 99%

“…1 Several risk factors have been identified to facilitate the development of AF in the early stage after HTX including the choice of surgical HTX technique (biatrial, bicaval, or total orthotopic HTX), distorted atrial anatomy with enlarged atrial cavities, proarrhythmic scar tissue, sinus node injury, mitral regurgitation, prolonged ischaemic time, cardiac allograft rejection, chronic obstructive pulmonary disease, increased pulmonary vascular resistance, and older donor age. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Although it is generally assumed that the donor atria are electrically isolated from the remnants of the recipient atria by suture lines, several case reports have reported recipient-to-donor atrioatrial conduction across the suture lines in HTX recipients. [18][19][20][21][22][23] Patients with AF before HTX may therefore be more likely to develop early post-transplant AF as an expression of a chronic disease state.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

et al. 2021

Self Cite

View full text Add to dashboard Cite

Aims Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. Methods and resultsThis study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. Conclusions Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.

show abstract

“…On the one hand, cardiac index needs to be significantly reduced (CI < 2.0 l/ min). On the other hand, this should not have led to a substantial increase in PVR as increased PVR (>3.5 WU) is associated with elevated perioperative death and worse prognosis (22,23). These partly contradictory requirements leave only a short window to list patients for heart transplantation.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter mitral valve repair may increase eligibility for heart transplant listing in patients with end-stage heart failure and severe secondary mitral regurgitation

Doldi

Buech

Orban

et al. 2021

International Journal of Cardiology

View full text Add to dashboard Cite

Background: Heart transplantation remains the gold standard for treatment of patients with end-stage heart failure and severely reduced ejection fraction (HFrEF). An increased pulmonary vascular resistance (PVR), which is often prevalent in HFrEF patients with secondary mitral regurgitation (SMR), limits the eligibility for transplantation. Therefore, we evaluated whether transcatheter mitral valve repair (TMVr) improves pulmonary circulatory hemodynamics and increases the eligibility for transplantation in end-stage HFrEF patients with severe SMR. Methods: We retrospectively analysed the hemodynamics by right heart catheterization (RHC) as well as laboratory and clinical outcomes of end-stage HFrEF patients with SMR that underwent TMVr. Results: Seventeen patients (age: 55 ± 10 yrs) underwent TMVr and repeat RHC at a mean follow-up of 5.7 ± 7.9 months. TMVr decreased PVR (3.5 ± 2.2 to 2.3 ± 1.2 wood units, p = 0.02) and systolic pulmonary artery pressure (55.4 ± 15 mmHg to 45.6 ± 9.8 mmHg, p = 0.02) from baseline to follow-up, respectively, while cardiac output was increased (3.7 ± 0.9 l/min to 4.6 ± 1.3 l/min, p = 0.02). In addition, transpulmonary gradient decreased significantly (12.0 ± 7.5 mmHg to 9.7 ± 5.3 mmHg, p = 0.04). The prevalence of New York Heart Association functional class ≥III at follow-up was reduced from 88% (15/17 patients) to 47% (8/17 patients, p = 0.01). All five patients with initially too high PVR (>3.5 WU) showed a significant decrease in PVR and three of them became potential candidates for heart transplantation after TMVr. Conclusion: TMVr is associated with reduction in PVR which may increase eligibility for transplantation in some HFrEF patients with severe SMR.

show abstract

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

Cited by 21 publications

References 45 publications

Pulmonary Artery Hypertension as A Risk Factor for Long-Term Survival after Heart Transplantation

Pulmonary Artery Hypertension as A Risk Factor for Long-Term Survival after Heart Transplantation

Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

Transcatheter mitral valve repair may increase eligibility for heart transplant listing in patients with end-stage heart failure and severe secondary mitral regurgitation

Contact Info

Product

Resources

About