Work

Afterload Mismatch Is Associated With Higher Cardiac Mortality After Heart Transplantation

Year: 2025

Type: article

Abstract: Background Heart transplant (HT) recipients tend to develop unfavorable ventricular–arterial interactions, yet the prognostic implications of this altered physiology remain unclear. We aimed to identify the presence of afterload mismatch (AM) after heart transplantation, its determinants, and its impact on long‐term cardiac mortality. Methods An observational, single‐center study was conducted on the historical cohort of patients who received HT at our institution. Patients survived the first year after HT with a LVEF ≥50%, cardiac allograft vasculopathy grades 0 to 1, and acute cellular rejection grades 0 to 1R. Arterial elastance and ventricular elastance were calculated noninvasively using blood pressure, end‐systolic volume, and end‐diastolic volume. Patients were grouped as follows: low afterload (LA— arterial elastance Results Overall, 345 patients who received HT were enrolled. Left ventricular ejection fraction was lower in AM (57%) than in LA and MHA (63% and 64%, respectively; P <0.0001); stroke volume was lower in AM than in LA but comparable between AM and MHA (27, 35, and 26 mL/m 2 for AM, LA, and MHA, respectively; P =0.0001). Predictors of AM were male recipient/male donor (β=0.15, P =0.0067) and male recipient/female donor (β=0.6, P =0.0078). After a median of 11.3 years, 59 recipients had died. Cardiac mortality was higher in the group with AM (AM median survival: 17.2, 27.8, and 24.1 years for AM, LA, and MHA, respectively; log‐rank P =0.005). After adjusting for confounding variables, AM was associated with cardiac mortality (hazard ratio [HR], 2.26 [95% CI, 1.18–4.35]; P =0.0143)as were male recipient/female donor (HR, 2.94 [95% CI], 1.18–4.35; P =0.0358). Conclusion Three phenotypes of patients who received HT were identified, and AM resulted as an independent predictor of cardiac mortality.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.124.040636