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Publications

Journal Article Epublish

PubMed: 42346447 DOI: 10.3390/jcdd13060227

Risk Stratification of Adverse Outcomes After Heart Transplantation with the 2022 Definition of Pulmonary Hypertension.

J Cardiovasc Dev Dis 13(6)

Authors: Mattia Corianò, Nicola Pradegan, Francesco Putortì, Arianna Calonaci, Andrea Golfetto, Vincenzo Tarzia, Annalisa Angelini, Chiara Tessari, Marny Fedrigo, Giuseppe Toscano, Gino Gerosa, Francesco Tona

Affiliations

  • Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35100 Padua, Italy.
  • Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35100 Padua, Italy.
  • Pathology and Pathological Anatomy Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35100 Padova, Italy.
  • Cardiovascular Pathology, Department of Integrated Diagnostic Services, Hospital-University of Padua, 35128 Padua, Italy.

Abstract

Pulmonary hypertension (PH) is associated with adverse outcomes after heart transplantation (HT). In 2022, the European Society of Cardiology introduced lower thresholds for pulmonary vascular resistance (PVR) to distinguish isolated post-capillary PH (IpcPH) and combined post-capillary PH (CpcPH). We conducted a single-center retrospective study on 357 patients who underwent HT between 1985 and 2020 and had right heart catheterization prior to transplant, investigating the ability of the new PVR threshold to predict one-year mortality. Overall, 65 patients had no PH, 84 had IpcPH, and 208 had CpcPH. One-year survival was higher in patients without PH and similar between IpcPH and CpcPH (p = 0.04). Reclassification under the 2022 guidelines did not improve risk prediction. Only mean pulmonary artery pressure (mPAP) >20 mmHg independently predicted 1-year mortality. In conclusion, elevated mPAP, rather than PVR, was associated with post-transplant outcomes. This finding opens up the possibility of rethinking indication for reversibility tests and mechanical circulatory support in HT recipients.

MeSH

Hypertension, Mortality, Hypertension, Pulmonary, Capillaries, Heart, Heart Transplantation, Transplants, Transplantation