Abstract 18326: Elevated Right Ventricular Operant Diastolic Elastance Strongly Predicts Increased Risk of Mortality Following Heart Transplantation

Background: Hemodynamic parameters are routinely measured at 1 year after heart transplant but their prognostic implications have not been extensively studied. Previous research has suggested that post-transplant right ventricular diastolic dysfunction (RVDD) is a strong predictor of cardiac mortalities. However, these results have not been independently validated. Thus, we aim to evaluate the incidence, correlates, and prognostic implication of post-transplant RVDD defined as elevated ventricular operant diastolic elastance (Ed). Methods: All patients who underwent heart transplantation at Stanford University between 1999 and 2011 with right-heart catheterization at 1-year post-transplant were included. RV Ed was calculated as mean right atrial pressure divided by stroke volume (SV). Left ventricular (LV) Ed was calculated as mean pulmonary capillary wedge pressure divided by SV. Predefined RV Ed greater than 120 mmHg/mL and LV Ed greater than 200 mmHg/mL were considered significantly elevated. Results: In total, 216 patients were included in the study with mean age of 49±15 years. Abnormal RV Ed and LV Ed were found in 23% and 27% of the patients, respectively. RV Ed and LV Ed were strongly correlated with an r= 0.89 (P<0.001). Logistic regression analysis revealed that pre-transplant ventilatory support, cyclosporine-based therapy, LVEF <55% at 1 year, and cardiac allograft vasculopathy (CAV) at 1 year were strongly associated with RVDD (OR 11 (95% CI 1.6-76), 2.5 (1.2-5.6), 4.4 (2.0-9.9), and 9.6 (1.7-56) respectively). Patients with RVDD were at significantly increased risk of death with adjusted HR of 3.28 (95% CI 1.8-5.8). Other significant independent correlates include pre-transplant life support and history of rejections at 1 year. Conclusion: Post-transplant RVDD at 1 year is a strong independent predictor of outcome following heart transplantation. Further studies are warranted to see whether therapies targeted for RVDD could improve outcome.