Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: a UNOS registry analysis
| Autor: | Kashan Syed Abidi, Kairav Vakil, Selcuk Adabag, Monica Colvin-Adams, Ziad Taimeh, Alok Sharma, Sue Duval |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Hypertension Pulmonary Pulmonary Artery law.invention law Predictive Value of Tests Risk Factors Internal medicine Artificial heart medicine.artery medicine Humans Registries Retrospective Studies Heart transplantation business.industry Hazard ratio Middle Aged medicine.disease Pulmonary hypertension Survival Analysis United States medicine.anatomical_structure Ventricular assist device Cohort Pulmonary artery Vascular resistance Cardiology Heart Transplantation Female Vascular Resistance Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | International journal of cardiology. 176(3) |
| ISSN: | 1874-1754 |
| Popis: | article Introduction: Severe pre-transplant pulmonary hypertension (PH) has been associated with adverse short-term clinical outcomes after heart transplantation in relatively small single-center studies. The impact of pre- transplant PH on long-term survival after heart transplantation has not been examined in a large, multi-center cohort. Methods:Adults (≥18 years) who underwent first time heart transplantation in the United States between 1987 and 2012 were retrospectively identified from the United Network for Organ Sharing registry. Pre-transplant PH was classified as mild, moderate, or severe based on pulmonary vascular resistance (PVR), trans-pulmonary gradient (TPG), and pulmonary artery (PA) mean pressure. Primary outcome was all-cause mortality. Results: Data from 26,649 heart transplant recipients (mean age 52 ± 12 years; 76% male; 76% Caucasian) were analyzed. During a mean follow-up of 5.7 ± 4.8 years, there were 10,334 (39%) deaths. Pre-transplant PH (PVR ≥ 2.5 WU) was a significant predictor of mortality (hazard ratio 1.10, 95% confidence interval 1.05-1.14, p b 0.0001) in multivariable analysis. However, the severity of pre-transplant PH (mild/moderate vs. severe) did not affect short or long-term survival. Similarly, even in patients who were supported with either a left ventricular assist device or a total artificial heart prior to transplant, severe pre-transplant PH was not associated with worse survival when compared to patients with mild/moderate pre-transplant PH. Conclusion:Pre-transplant PH (PVR ≥ 2.5 WU) is associated with a modest increase in mortality when compared topatientswithoutpre-transplantPH.However,theseverityof pre-transplantPH,assessedbyPVR,TPG,ormean PA pressure, is not a discriminating factor for poor survival in patients listed for heart transplantation. |
| Databáze: | OpenAIRE |
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