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| Content Provider | frontiers |
|---|---|
| Author | Kakuda, Nobutaka Amiya, Eisuke Hatano, Masaru Tsuji, Masaki Bujo, Chie Ishida, Junichi Yagi, Hiroki Saito, Akihito Narita, Koichi Isotani, Yoshitaka Fujita, Kanna Ando, Masahiko Shimada, Shogo Kinoshita, Osamu Ono, Minoru Komuro, Issei |
| Abstract | Aims We compared hemodynamics and clinical events after heart transplantation (HTx) in patients stratified by the severity of residual pulmonary vascular resistance (PVR) after left ventricular assist device (LVAD) implantation for bridge to transplantation (BTT). Methods We retrospectively analyzed patients who had undergone HTx at the University of Tokyo Hospital. We defined the high PVR group as patients with PVR of > 3 Wood Units (WU) as measured by right heart catheterization performed 1 month after LVAD implantation. Results We included 85 consecutive HTx recipients, 20 of whom were classified in the high PVR group and 65 in the low PVR group. The difference in PVR between the two groups became apparent at 2 years after HTx (the high PVR group: 1.77 ± 0.41 WU, the low PVR group: 1.24 ± 0.59 WU, p = 0.0009). The differences in mean pulmonary artery pressure (mPAP), mean right arterial pressure (mRAP), and mean pulmonary capillary wedge pressure (mPCWP) tended to increase from the first year after HTx, and were all significantly higher in the high PVR group at 3 years after HTx. (mPAP : 22.7 ± 9.0 mmHg vs 15.4 ± 4.3 mmHg, p = 0.0009, mRAP : 7.2 ± 3.6 mmHg vs 4.1 ± 2.1 mmHg, p = 0.0042, mPCWP : 13.4±4.5 mmHg, 8.8 ± 3.3 mmHg, p = 0.0040). In addition, pulmonary artery pulsatility index (PAPi) was significantly lower in the high PVR group than in the low PVR group at 3 years after HTx (2.51 ± 1.00 vs 5.21 ± 3.23, p = 0.0033). The composite event including hospitalization for heart failure, diuretic use, and elevated intracardiac pressure (mRAP ≥ 12 mmHg or mPCWP ≥ 18 mmHg) between the two groups was significantly more common in the high PVR group. Residual high PVR was still an important predictor (hazard ratio (HR) 6.5, 95% confidence interval (CI) 2.0-21.6, p = 0.0023) after multivariate Cox regression analysis. Conclusion Our study demonstrates that patients with residual high PVR under LVAD implantation showed the increase of right and left atrial pressure in the chronic phase after HTx. |
| ISSN | 2297055X |
| DOI | 10.3389/fcvm.2022.904350 |
| Volume Number | 9 |
| Journal | Frontiers in Cardiovascular Medicine |
| Language | English |
| Publisher Date | 2022-06-01 |
| Access Restriction | Open |
| Subject Keyword | Heart Transplantation Left ventricular assist device Heart Failure Rejection Pulmonary vascular resistance |
| Content Type | Text |
| Resource Type | Article |
| Subject | Cardiology and Cardiovascular Medicine |
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