Key result
Post-transplant diabetes mellitus was associated with lower ejection fraction at 5 years (52% vs 57%, p=0.002) and persistently impaired global longitudinal strain.
Why the study?
Post-transplant diabetes mellitus is common after orthotopic heart transplantation, but its long-term impact on myocardial function remains unclear.
Does post-transplant diabetes mellitus impair left ventricular systolic function in orthotopic heart transplantation recipients?
Cohort (n=102)
Does post-transplant diabetes mellitus impair left ventricular systolic function in orthotopic heart transplantation recipients?
Absolute Event Rate: 52% vs 57%
p-value: p=0.002
Post-transplant diabetes mellitus is associated with early and persistent impairment in myocardial deformation and progressive decline in systolic function, independent of cardiac allograft vasculopathy.
PTDM was associated with reduced EF and GLS after heart transplant; leaves open whether glycemic control preserves systolic function.
Background Post-transplant diabetes mellitus (PTDM) is common after orthotopic heart transplantation (OHT), but its long-term impact on myocardial function is unclear. We aimed to evaluate the effects of PTDM on left ventricular (LV) systolic function. Methods We prospectively studied 102 OHT recipients with echocardiographic follow-up at 1-, 3-, and 5-year post-transplant. Patients were classified according to PTDM status at 1 year. LV systolic function was assessed using ejection fraction (EF) and global longitudinal strain (GLS). Linear mixed-effects models were used to evaluate longitudinal associations, adjusting for age, sex, systolic blood pressure, and cardiac allograft vasculopathy (CAV). Results PTDM was present in 36% of patients. At 1-year, EF and GLS were similar between groups. At 3 years, patients with PTDM exhibited significantly lower systolic function as assessed by GLS (−14.9±2.8 vs. −16.0±3.0%, p=0.022), and at 5-years, EF was also significantly lower (52±4 vs. 57±7%, p=0.002). In longitudinal analyses, PTDM was associated with persistently impaired GLS without a significant interaction with time (p=0.192). In contrast, EF demonstrated a significant PTDM×time interaction (p=0.039), reflecting a greater decline over time in patients with PTDM. These associations remained significant after adjustment for CAV, which was not independently associated with GLS or EF. Conclusion PTDM after OHT is associated with early and persistent impairment in myocardial deformation, followed by a progressive decline in systolic function. These findings suggest a metabolically mediated myocardial effect independent of chronic graft failure and highlight the importance of early detection and management of PTDM in heart transplant recipients.
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Evaldsson et al. (2026) conducted a cohort in Orthotopic heart transplantation (n=102). Post-transplant diabetes mellitus vs. No post-transplant diabetes mellitus was evaluated on Left ventricular ejection fraction at 5 years (p=0.002). Post-transplant diabetes mellitus was associated with lower ejection fraction at 5 years (52% vs 57%, p=0.002) and persistently impaired global longitudinal strain.
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