TY - JOUR
T1 - Incremental Value of Deformation Imaging and Hemodynamics Following Heart Transplantation
T2 - Insights From Graft Function Profiling
AU - Kobayashi, Yukari
AU - Sudini, Naga Lakshmi
AU - Rhee, June Wha
AU - Aymami, Marie
AU - Moneghetti, Kegan J.
AU - Bouajila, Sara
AU - Kobayashi, Yuhei
AU - Kim, Juyong B.
AU - Schnittger, Ingela
AU - Teuteberg, Jeffery J.
AU - Khush, Kiran K.
AU - Fearon, William F.
AU - Haddad, Francois
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/12
Y1 - 2017/12
N2 - Objectives This study investigated to define graft dysfunction and to determine its incremental association with long-term outcome after heart transplantation (HT). Background Although graft failure is an established cause of late mortality after HT, few studies have analyzed the prognostic value of graft dysfunction at 1- and 5-year follow-up of HT. Methods Patients who underwent HT and completed their first annual evaluation with right heart catheterization and echocardiography at Stanford University between January 1999 and December 2011 were included in the study. Hierarchical clustering was used to identify modules to capture independent features of graft dysfunction at 1 year. The primary endpoint for analysis consisted of the composite of cardiovascular mortality, re-transplantation, or heart failure hospitalization within 5 years of HT. The study further explored whether changes in graft dysfunction between 1 and 5 years were associated with 10-year all-cause mortality. Results A total of 215 HT recipients were included in the study. Using hierarchical clustering, 3 functional modules were identified; among them, left ventricular global longitudinal strain (LVGLS), stroke volume index, and right atrial pressure (RAP) or pulmonary capillary wedge pressure (PCWP) captured key features of graft function. Graft dysfunction based on pre defined LVGLS in absolute value <14%, stroke volume index <35 ml/m2, RAP >10 mm Hg, or PCWP >15 mm Hg were present in 41%, 36%, and 27%, respectively. The primary endpoint at 5 years occurred in 52 patients (24%), whereas 10-year all-cause mortality occurred in 30 (27%) of 110 patients alive at 5 years. On multivariate analysis, RAP (standardized hazard ratio: 1.63), LVGLS (standardized hazard ratio: 1.39), and a history of hemodynamically compromising rejection within 1 year (hazard ratio: 2.18) were independent predictors of 5-year outcome. RAP at 5 years, as well as change in RAP from 1 to 5 years, was predictive of 10-year all-cause mortality. Conclusions RAP and LVGLS at the first annual evaluation provide complementary prognostic information in predicting 5-year outcome after HT.
AB - Objectives This study investigated to define graft dysfunction and to determine its incremental association with long-term outcome after heart transplantation (HT). Background Although graft failure is an established cause of late mortality after HT, few studies have analyzed the prognostic value of graft dysfunction at 1- and 5-year follow-up of HT. Methods Patients who underwent HT and completed their first annual evaluation with right heart catheterization and echocardiography at Stanford University between January 1999 and December 2011 were included in the study. Hierarchical clustering was used to identify modules to capture independent features of graft dysfunction at 1 year. The primary endpoint for analysis consisted of the composite of cardiovascular mortality, re-transplantation, or heart failure hospitalization within 5 years of HT. The study further explored whether changes in graft dysfunction between 1 and 5 years were associated with 10-year all-cause mortality. Results A total of 215 HT recipients were included in the study. Using hierarchical clustering, 3 functional modules were identified; among them, left ventricular global longitudinal strain (LVGLS), stroke volume index, and right atrial pressure (RAP) or pulmonary capillary wedge pressure (PCWP) captured key features of graft function. Graft dysfunction based on pre defined LVGLS in absolute value <14%, stroke volume index <35 ml/m2, RAP >10 mm Hg, or PCWP >15 mm Hg were present in 41%, 36%, and 27%, respectively. The primary endpoint at 5 years occurred in 52 patients (24%), whereas 10-year all-cause mortality occurred in 30 (27%) of 110 patients alive at 5 years. On multivariate analysis, RAP (standardized hazard ratio: 1.63), LVGLS (standardized hazard ratio: 1.39), and a history of hemodynamically compromising rejection within 1 year (hazard ratio: 2.18) were independent predictors of 5-year outcome. RAP at 5 years, as well as change in RAP from 1 to 5 years, was predictive of 10-year all-cause mortality. Conclusions RAP and LVGLS at the first annual evaluation provide complementary prognostic information in predicting 5-year outcome after HT.
KW - diastolic dysfunction
KW - heart transplantation
KW - rejection
KW - right heart catheterization
UR - http://www.scopus.com/inward/record.url?scp=85035792143&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85035792143&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2017.10.011
DO - 10.1016/j.jchf.2017.10.011
M3 - Article
C2 - 29191301
AN - SCOPUS:85035792143
SN - 2213-1779
VL - 5
SP - 930
EP - 939
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 12
ER -