The Outcome of Restrictive Cardiac Allograft Physiology in Severe Coronary Allograft Vasculopathy.
J Heart Lung Transplant
; 2024 Oct 04.
Article
in En
| MEDLINE
| ID: mdl-39369967
ABSTRACT
BACKGROUND:
Microvascular dysfunction after heart transplantation leads to restrictive cardiac allograft physiology (RCP), which is classified as severe coronary allograft vasculopathy (CAV); however, the prognosis of RCP remains unclear. Therefore, in this study, we aimed to elucidate the prognosis of RCP in comparison with that of severe angiographic CAV.METHODS:
We assessed 116 patients with severe CAV who underwent heart transplantation between 2004 and 2023. RCP was defined as symptomatic heart failure with restrictive hemodynamic values (mean right atrial pressure >12 mmHg, pulmonary capillary wedge pressure >25 mmHg, and cardiac index <2.0 L/min/m2). The primary outcome was death or re-transplantation.RESULTS:
Of the 116 patients with severe CAV, 42 had RCP (RCP-CAV group) and 74 had severe angiographic CAV without RCP (Angio-CAV group). A significantly shorter time from heart transplantation to diagnosis and lower subsequent percutaneous catheter intervention after diagnosis were seen in the RCP-CAV group than in the Angio-CAV group (both p<0.001). Freedom from death or re-transplantation at 5 years was significantly worse in the RCP-CAV group compared to the Angio-CAV group (18.4% vs 35.4%, p=0.001). In the Cox proportional hazard model, RCP was independently associated with an increased risk of death or re-transplantation (hazard ratio 2.08, 95% confidence intervals 1.26-3.44, p=0.004).CONCLUSIONS:
The prognosis of patients with RCP was significantly worse than that of patients with severe angiographic CAV. The early detection of microvascular dysfunction and re-transplantation listing may improve the prognosis of patients with RCP.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
J Heart Lung Transplant
Journal subject:
CARDIOLOGIA
/
TRANSPLANTE
Year:
2024
Type:
Article