Related Experiment Video
Updated: Jun 27, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Cardiac allograft remodeling after heart transplantation is associated with increased graft vasculopathy and
E Raichlin1, H R Villarraga, K Chandrasekaran
1Division of Cardiology, William J. Von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA.
Insights
Left ventricular remodeling is common after heart transplantation (HTX), with abnormal geometry seen in 85% of patients early on. Concentric hypertrophy at 1 year predicts increased mortality and graft arteriosclerosis.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiac Imaging
Background:
- Left ventricular remodeling (LVR) is a significant concern following heart transplantation (HTX).
- Understanding LVR patterns, predictors, and outcomes is crucial for improving graft survival and patient prognosis.
Purpose of the Study:
- To investigate the temporal patterns of left ventricular geometry after HTX.
- To identify predictors of left ventricular remodeling.
- To evaluate the impact of LVR on mortality and graft arteriosclerosis.
Main Methods:
- Echocardiographic studies analyzed in 134 HTX recipients at 1 week, 1 year, and 3-5 years post-transplant.
- Patients categorized into normal geometry (NG), concentric remodeling (CR), and concentric hypertrophy (CH) groups.
- Statistical analysis to determine predictors and outcomes associated with LVR.
Main Results:
- Abnormal left ventricular geometry was present in 85% of patients by 1 week post-HTX.
- Explosive donor brain death predicted early concentric hypertrophy (CH).
- CH at 1 week, elevated BMI, and cytomegalovirus viremia predicted 1-year CH.
- 1-year CH was linked to increased mortality (RR 1.87) and graft arteriosclerosis (RR 2.04).
- 1-year CR also associated with increased graft arteriosclerosis (RR 1.73).
Conclusions:
- Left ventricular remodeling is prevalent and occurs early after heart transplantation.
- Specific donor and recipient factors predict the development of concentric hypertrophy.
- Concentric remodeling and hypertrophy of the cardiac allograft are associated with adverse long-term outcomes, including mortality and graft arteriosclerosis.
Abstract:
The aim of this study was to assess the patterns, predictors and outcomes of left ventricular remodeling after heart transplantation (HTX). Routine echocardiographic studies were performed and analyzed at 1 week, 1 year and 3-5 years after HTX in 134 recipients. At each study point the total cohort was divided into three subgroups based on determination of left ventricle mass and relative wall thickness: (1) NG-normal geometry (2) CR-concentric remodeling and (3) CH-concentric hypertrophy. Abnormal left ventricular geometry was found as early as 1 week after HTX in 85% of patients. Explosive mode of donor brain death was the most significant determinant of CH (OR 2.9, p = 0.01) at 1 week. CH at 1 week (OR 2.72, p = 0.01), increased body mass index (OR 1.1, p = 0.01) and cytomegalovirus viremia (OR - 4.06, p = 0.02) were predictors of CH at 1 year. CH of the cardiac allograft at 1 year was associated with increased mortality as compared to NG (RR 1.87, p = 0.03). CR (RR 1.73, p = 0.027) and CH (RR 2.04, p = 0.008) of the cardiac allograft at 1 year is associated with increased subsequent graft arteriosclerosis as compared to NG.
