Related Experiment Video
Updated: Aug 13, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Impaired left ventricular systolic function early after heart transplantation is associated with cardiac allograft
I A Bolad1, D R Robinson, C Webb
1Transplant Unit, Harefield Hospital, Royal Brompton and Harefield NHS Trust, Hill End Road, Harefield, Middlesex UB9 6JH, UK.
Insights
Early left ventricular systolic dysfunction after heart transplantation predicts cardiac allograft vasculopathy (CAV). Lower initial fractional shortening (FS) is linked to greater mean lumen diameter loss (MLDL), a key indicator of CAV development.
Area of Science:
- Cardiology
- Transplantation Immunology
Background:
- Cardiac allograft vasculopathy (CAV) is a leading cause of late mortality post-heart transplantation.
- Identifying predictive factors for CAV is crucial for improving long-term patient survival.
Purpose of the Study:
- To investigate the role of etiological factors in the development of CAV.
- To assess the predictive value of various factors on CAV progression using quantitative coronary angiography (QCA).
Main Methods:
- 121 heart transplant recipients underwent baseline QCA; 117 had a 1-year follow-up QCA.
- Mean lumen diameter loss (MLDL) was measured in main coronary arteries.
- Association of MLDL with immunological and non-immunological factors was analyzed via univariate and multivariate models.
Main Results:
- Univariate analysis revealed MLDL inversely correlated with early echocardiographic fractional shortening (FS) and donor intracranial hemorrhage, and directly with male donors, domino transplants, and donor cytomegalovirus (CMV) negativity.
- Multivariate analysis identified initial FS and donor intracranial hemorrhage as inversely related to MLDL.
- Donor male sex and continuous prednisolone treatment were directly related to MLDL.
Conclusions:
- Early left ventricular systolic dysfunction, indicated by reduced initial FS, is associated with subsequent CAV development.
- Donor characteristics and immunosuppressive therapy (prednisolone) also play a role in CAV pathogenesis.
Abstract:
Cardiac allograft vasculopathy (CAV) is a major cause of death more than 1 year after heart transplantation. We evaluated the role and possible predictive value of different etiological factors on development of CAV as diagnosed by quantitative coronary angiography (QCA). A total of 121 patients were studied with baseline QCA and 117 had a follow-up study at 1 year to assess the relationship of mean lumen diameter loss (MLDL) in main coronary arteries to immunological and non-immunological factors potentially affecting long-term survival. Out of them, 103 patients were males (85%), 114 (94%) patients were Caucasians and mean age was 48.5 +/- 10 years. Univariate analysis showed that MLDL at 1 year was inversely related to echocardiographic fractional shortening (FS) measured within the first week after transplantation (p = 0.0098) and to intracranial hemorrhage as cause of donor death (p = 0.04) and was directly related to male donors (p = 0.0008), domino transplants (p = 0.037) and donor negative cytomegalovirus (CMV) status (p = 0.022). Multivariate analysis showed that initial FS (p = 0.006) and donor intracranial hemorrhage as a cause of death (p = 0.042) were inversely related to MLDL whereas donor male sex (p = 0.003) and prednisolone treatment throughout the first year (p = 0.012) were directly related. Thus, left ventricular systolic dysfunction early after heart transplantation was associated with subsequent development of CAV.
