Evaluation of restrictive left ventricular physiology on echocardiography in heart transplant recipients and early angiographic cardiac allograft vasculopathy

This retrospective observational study aimed to determine whether echocardiographic markers of restrictive physiology can identify early cardiac allograft vasculopathy (CAV). There were 136 heart transplant (HT) recipients evaluated between January 2018 and December 2023. The echocardiographic parameters assessed were E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT), E/e', and tissue Doppler indices. The primary outcome was angiographic CAV (ISHLT grade ≥1) at 1 year, which was observed in 15% of recipients. Only DT <150 ms was significantly associated with CAV (OR 2.73, 95% CI 1.03–7.21). A multivariable model incorporating age, sex, and DT <150 ms demonstrated good discrimination for CAV (AUC 0.78). These findings suggest that DT may be a non-invasive marker of early CAV and merit further studies to determine long-term risk prediction.