Early post-transplant elevated pulmonary artery pressure predicts adverse outcome in cardiac recipients

Entela Bollano; Bert Andersson; Clara Hjalmarsson; Göran Dellgren; Bledar Daka; Kristjan Karason

doi:10.1016/j.ijcha.2019.100438

Early post-transplant elevated pulmonary artery pressure predicts adverse outcome in cardiac recipients

Int J Cardiol Heart Vasc. 2019 Nov 19:26:100438. doi: 10.1016/j.ijcha.2019.100438. eCollection 2020 Feb.

Authors

Entela Bollano^{1

2}, Bert Andersson^{1

2}, Clara Hjalmarsson^{1

3}, Göran Dellgren^{3

4

2}, Bledar Daka^{5

2}, Kristjan Karason^{3

4

2}

Affiliations

¹ Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
² Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Department of Primary Health Care, University of Gothenburg, Gothenburg, Sweden.

Abstract

Aim: To investigate the prognostic value of early post-transplant hemodynamic measurements on 5-year mortality in cardiac recipients (HTx).

Methods: A right heart catheterization was performed in 290 heart transplantation (HTx) recipients at a one-year post-HTx evaluation. To study the effect of post-HTx hemodynamic variables on 5-year outcome, the cohort was stratified into several subgroups. For right atrial pressure (RAP), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), and pulmonary vascular resistance (PVR), patients with values from the upper 10th percentile (high), were compared with those with values from the remaining lower 90th percentile (normal). For cardiac index (CI), patients with values from the lower 10th percentile (low) were compared with those with values from the remaining upper 90th percentile (normal).

Results: Death or re-transplantation within 5 years after the one-year control occurred in 44 patients (13%). Of those, death or re-HTx was related to graft failure in 20 of cases (45%) and non-cardiac causes in 24 of cases (55%). The risk of death or re-HTx was higher in the subgroup with MPAP above 23 mmHg than those equal to or below this value [hazard ratio 3.22, 95% confidence interval (CI) 1.49-6.97; P = 0.003]. The association remained significant despite adjustment for several comorbidities. There were no differences in outcome between subgroups stratified with respect to high versus low RAP, PAWP, CI or PVR.

Conclusion: Elevated pulmonary artery pressure at a first annual evaluation after HTx was the only hemodynamic variable that predicted impaired outcome in cardiac recipients.

Keywords: Heart transplantation; Hemodynamics; Pulmonary arterial hypertension.