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Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database
BACKGROUND: Predicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common d...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9800977/ https://www.ncbi.nlm.nih.gov/pubmed/36588552 http://dx.doi.org/10.3389/fcvm.2022.1036547 |
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author | Wagner, Tobias Magnussen, Christina Bernhardt, Alexander Smits, Jacqueline M. Steinbach, Katrin Reichenspurner, Hermann Kirchhof, Paulus Grahn, Hanno |
author_facet | Wagner, Tobias Magnussen, Christina Bernhardt, Alexander Smits, Jacqueline M. Steinbach, Katrin Reichenspurner, Hermann Kirchhof, Paulus Grahn, Hanno |
author_sort | Wagner, Tobias |
collection | PubMed |
description | BACKGROUND: Predicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common driver of mortality. The diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) can differentiate post- from combined pre- and post-capillary PH and may improve estimation of PH-associated risks. We used a large European cohort of transplant candidates to assess whether the pulmonary pulsatility index (PAPi), improves prediction of graft failure and mortality compared to DPG and PVR. METHODS: Out of all patients undergoing heart transplantation between 2009 and 2019 in Eurotransplant member states (n = 10,465), we analyzed the impact of PH (mPAP > 25 mmHg) and right heart catheter hemodynamic data on graft failure and mortality within 1–5 years. RESULTS: In 1,407 heart transplant patients with PH (79% male, median age 54 years, IQR 39–69 years), the median PVR was 2.5 WU (IQR 1.6 WU) with a median mPAP (pulmonary arterial pressure) of 32 mmHg (IQR 9 mmHg). Patients with low (< 3 mmHg) DPG had a better 5 year survival than those with higher DPG (log rank p = 0.023). TPG, mPAP, PAPi, and PVR did not improve prediction of survival. Low PAPi (OR = 2.24, p < 0.001) and high PVR (OR = 2.12, p = 0.005) were associated with graft failure. CONCLUSION: PAPI and PVR are associated with graft failure in patients with PH undergoing cardiac transplantation. DPG is associated with survival in this cohort. |
format | Online Article Text |
id | pubmed-9800977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-98009772022-12-31 Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database Wagner, Tobias Magnussen, Christina Bernhardt, Alexander Smits, Jacqueline M. Steinbach, Katrin Reichenspurner, Hermann Kirchhof, Paulus Grahn, Hanno Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Predicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common driver of mortality. The diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) can differentiate post- from combined pre- and post-capillary PH and may improve estimation of PH-associated risks. We used a large European cohort of transplant candidates to assess whether the pulmonary pulsatility index (PAPi), improves prediction of graft failure and mortality compared to DPG and PVR. METHODS: Out of all patients undergoing heart transplantation between 2009 and 2019 in Eurotransplant member states (n = 10,465), we analyzed the impact of PH (mPAP > 25 mmHg) and right heart catheter hemodynamic data on graft failure and mortality within 1–5 years. RESULTS: In 1,407 heart transplant patients with PH (79% male, median age 54 years, IQR 39–69 years), the median PVR was 2.5 WU (IQR 1.6 WU) with a median mPAP (pulmonary arterial pressure) of 32 mmHg (IQR 9 mmHg). Patients with low (< 3 mmHg) DPG had a better 5 year survival than those with higher DPG (log rank p = 0.023). TPG, mPAP, PAPi, and PVR did not improve prediction of survival. Low PAPi (OR = 2.24, p < 0.001) and high PVR (OR = 2.12, p = 0.005) were associated with graft failure. CONCLUSION: PAPI and PVR are associated with graft failure in patients with PH undergoing cardiac transplantation. DPG is associated with survival in this cohort. Frontiers Media S.A. 2022-12-16 /pmc/articles/PMC9800977/ /pubmed/36588552 http://dx.doi.org/10.3389/fcvm.2022.1036547 Text en Copyright © 2022 Wagner, Magnussen, Bernhardt, Smits, Steinbach, Reichenspurner, Kirchhof and Grahn. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Wagner, Tobias Magnussen, Christina Bernhardt, Alexander Smits, Jacqueline M. Steinbach, Katrin Reichenspurner, Hermann Kirchhof, Paulus Grahn, Hanno Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database |
title | Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database |
title_full | Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database |
title_fullStr | Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database |
title_full_unstemmed | Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database |
title_short | Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database |
title_sort | impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—results from the eurotransplant database |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9800977/ https://www.ncbi.nlm.nih.gov/pubmed/36588552 http://dx.doi.org/10.3389/fcvm.2022.1036547 |
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