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.