Pretransplant Right Ventricular Dysfunction Is Associated With Increased Mortality After Heart Transplantation: A Hard Inheritance to Overcome
| Autor: | Matteo Bellettini, Claudia Raineri, Davide Pacini, Antonio Loforte, Gaetano M. De Ferrari, Sofia Martin Suarez, M. Sabatino, Guglielmo Gallone, Federica Bongiovanni, Paolo Boretto, Luciano Potena, Mauro Rinaldi, Marco Masetti, Massimo Boffini, Simone Frea, Stefano Pidello |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Adult
medicine.medical_specialty Ventricular Dysfunction Right medicine.medical_treatment Hemodynamics Heart transplantation Logistic regression Internal medicine medicine.artery medicine Ventricular Dysfunction Humans Ventricular Function Retrospective Studies Heart Failure business.industry PAPi right heart failure Middle Aged medicine.disease Right ventricular dysfunction advanced heart failure Right medicine.anatomical_structure pulmonary artery pulsatility index Ventricular assist device Heart failure right ventricular dysfunction Female Ventricular Function Right Heart Transplantation Heart-Assist Devices Pulmonary artery Vascular resistance Cardiology Cardiology and Cardiovascular Medicine business |
| Popis: | Right ventricular dysfunction (RVD) is a major issue in patients with advanced heart failure because it precludes the implantation of left ventricular assist device, usually leaving heart transplantation (HTx) as the only available treatment option. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating information of right ventricular function and of pulmonary circulation. Our aim is to evaluate the association of preoperative RVD, hemodynamically defined as a low PAPi, with post-HTx survival.Consecutive adult HTx recipient at 2 Italian transplant centers between 2000 and 2018 with available data on pre-HTx right heart catheterization were included retrospectively. RVD was defined as a value of PAPi lower than the 25th percentile of the study population. The association of RVD with the 1-year post-HTx mortality and other secondary end points were evaluated. Multivariate logistic regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by pulmonary vascular resistance (PVR) status (≥3 Woods units vs3 Woods units) were also performed. Among 657 HTx recipients (female 31.1%, age 53 ± 11 years), patients with pre-HTx RVD (PAPi of1.68) had significantly lower 1-year survival rates (77.8% vs 87.1%, P = .005), also after adjusting for estimated glomerular filtration rate, total bilirubin, PVR, serum sodium, inotropes, and mechanical circulatory support at HTx (hazard ratio 2.0, 95% confidence interval, 1.3-3.1). RVD was also associated with post-HTx renal replacement therapy (hazard ratio 2.0, 95% confidence interval 1.05-3.30) and primary graft dysfunction (hazard ratio 1.7, , 95% confidence interval 1.02-3.30). When stratifying patients by estimated PVR status, RVD was associated with worse 1-year survival among patients with normal PVR (76.9% vs 88.3%, P = .003), but not in those with increased PVR (78.6% vs 83.2%, P = .49).Preoperative RVD, evaluated through PAPi, is associated with mortality and morbidity after HTx, providing incremental prognostic value over traditional clinical and hemodynamic parameters. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|