Key result
Elevated pre-transplant PVR ≥3.75 Wood units linked to ~340% higher 30-day mortality after heart transplant.
Why the study?
The impact of a moderately increased pre-transplant pulmonary vascular resistance on post-transplant outcomes remains uncertain.
Does elevated pre-transplant pulmonary vascular resistance (PVR ≥ 300 dyn·s·cm−5) increase the risk of early post-transplant atrial fibrillation and mortality in patients receiving heart transplantation?
Observational (n=561)
No
Does elevated pre-transplant pulmonary vascular resistance (PVR ≥ 300 dyn·s·cm−5) increase the risk of early post-transplant atrial fibrillation and mortality in patients receiving heart transplantation?
Hazard Ratio: 4.4 (95% CI 2.6–7.6)
Absolute Event Rate: 25.5% vs 6.4%
p-value: p=<0.01
Moderately elevated pre-transplant pulmonary vascular resistance (≥3.75 Wood units) is a significant risk factor for early post-transplant atrial fibrillation and increased 30-day mortality.
Elevated pre-transplant PVR may identify higher early-mortality risk after transplantation; leaves open whether PVR-targeted interventions improve outcomes.
Aims Severely elevated pre-transplant pulmonary vascular resistance (PVR) has been linked to adverse effects after heart transplantation (HTX). The impact of a moderately increased PVR before HTX on post-transplant outcomes remains uncertain. The aim of this study was to investigate the effects of an elevated pre-transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) on outcomes after HTX. Methods and results This observational retrospective single-centre study included 561 patients receiving HTX at Heidelberg Heart Center between 1989 and 2015. Patients were stratified by degree of pre-transplant PVR. Analyses covered demographics, post-transplant medication, mortality and causes of death after HTX, early post-transplant atrial fibrillation (AF), and length of the initial hospital stay after HTX. Ninety-four patients (16.8%) had a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). These patients had a higher rate of early post-transplant AF [20.2 vs. 10.7%, difference: 9.5%, 95% confidence interval (CI): 0.9–18.1%, P = 0.01] and an increased 30 day post-transplant mortality (25.5 vs. 6.4%, hazard ratio: 4.4, 95% CI: 2.6–7.6, P < 0.01), along with a higher percentage of death due to transplant failure (21.2 vs. 4.1%, difference: 17.1%, 95% CI: 8.7–25.5%, P < 0.01). Multivariate analysis revealed a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) as a significant risk factor for increased 30 day mortality after HTX (hazard ratio: 4.4, 95% CI: 2.5–7.6, P < 0.01). Kaplan–Meier estimator showed a lower 2 year survival after HTX (P < 0.01) in patients with a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). Conclusions Elevated pre-transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) is associated with early post-transplant AF and increased mortality after HTX.
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Rivinius et al. (2020) conducted an observational in Heart transplantation (n=561). Elevated pre-transplant pulmonary vascular resistance ≥ 300 dyn·s·cm−5 vs. PVR < 300 dyn·s·cm−5 was evaluated on 30 day post-transplant mortality (HR 4.4, 95% CI 2.6-7.6, p=<0.01). Elevated pre-transplant pulmonary vascular resistance ≥3.75 Wood units was associated with increased 30-day mortality after heart transplantation (25.5% vs 6.4%; HR 4.4; 95% CI 2.6-7.6; P<0.01).
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