Elevated pre-transplant pulmonary vascular resistance is associated with early post-transplant atrial fibrillation and mortality

• Verfasst von: Rivinius, Rasmus [VerfasserIn]
• Verfasst von: Helmschrott, Matthias [VerfasserIn]
• Verfasst von: Ruhparwar, Arjang [VerfasserIn]
• Verfasst von: Schmack, Bastian [VerfasserIn]
• Verfasst von: Darche, Fabrice Fernand [VerfasserIn]
• Verfasst von: Thomas, Dierk [VerfasserIn]
• Verfasst von: Bruckner, Thomas [VerfasserIn]
• Verfasst von: Dösch, Andreas [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Ehlermann, Philipp [VerfasserIn]
• Titel: Elevated pre-transplant pulmonary vascular resistance is associated with early post-transplant atrial fibrillation and mortality
• Verf.angabe: Rasmus Rivinius, Matthias Helmschrott, Arjang Ruhparwar, Bastian Schmack, Fabrice F. Darche, Dierk Thomas, Tom Bruckner, Andreas O. Doesch, Hugo A. Katus and Philipp Ehlermann
• E-Jahr: 2020
• Jahr: 20 March 2020
• Umfang: 12 S.
• Illustrationen: Diagramme
• Fussnoten: Gesehen am 14.04.2020
• Titel Quelle: Enthalten in: European Society of CardiologyESC heart failure
• Ort Quelle: Chichester : Wiley, 2014
• Jahr Quelle: 2020
• Band/Heft Quelle: 7(2020), 1, Seite 177-188
• ISSN Quelle: 2055-5822
• DOI: doi:10.1002/ehf2.12549
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Atrial fibrillation
• Sach-SW: Heart transplantation
• Sach-SW: Length of initial hospital stay
• Sach-SW: Mortality
• Sach-SW: Pulmonary vascular resistance
• K10plus-PPN: 1694432122

Abstract

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.