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Updated: May 30, 2026
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
Heart rate and cardiac allograft vasculopathy in heart transplant recipients
Francesca Olmetti1, Gian Domenico Pinna, Roberto Maestri
1Divisione di Cardiologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, (Pavia), Italy.
Insights
In heart transplant recipients, a lower heart rate (HR) (<90 bpm) was unexpectedly linked to increased cardiac allograft vasculopathy (CAV). Higher HR did not predict CAV, suggesting HR reflects donor age, not a risk factor.
Area of Science:
- Cardiology
- Transplant Medicine
- Immunology
Background:
- Elevated heart rate (HR) is a known cardiovascular disease risk factor.
- Sinus tachycardia is common in heart transplant patients due to absent autonomic control.
- This study investigated the role of HR in cardiac allograft vasculopathy (CAV) development.
Purpose of the Study:
- To assess the association between heart rate (HR) and cardiac allograft vasculopathy (CAV) in heart transplant recipients.
- To determine if HR is an independent predictor of CAV in the denervated heart.
Main Methods:
- Analysis of data from 244 heart transplant recipients.
- Mean HR from 24-hour recordings at 1 year post-transplant, dichotomized at ≥90 beats/min.
- Univariate and multivariable Cox analyses were performed, adjusting for known CAV risk factors.
Main Results:
- Cardiac allograft vasculopathy (CAV) developed in 25% of patients over a median of 96 months.
- Surprisingly, a mean HR < 90 beats/min, not ≥90 beats/min, was significantly associated with increased CAV development.
- Multivariable analysis identified donor's age, chronic renal failure, and LV end-diastolic wall thickness as significant CAV predictors.
Conclusions:
- In denervated hearts, sinus tachycardia is not a risk factor for coronary atherosclerosis.
- Heart rate in heart transplant recipients reflects intrinsic heart rate and is an epiphenomenon of donor age.
- Lower HR may be a marker for older donor age, indirectly linked to CAV risk.
Background:
Elevated heart rate (HR) has been indicated as risk factor for cardiovascular disease. Experimental data support a role of HR in the progression and severity of atherosclerotic lesions. Sinus tachycardia is common in heart transplant patients due to the lack of autonomic control. This study assessed the role of HR in the development of cardiac allograft vasculopathy (CAV) in heart transplant recipients.
Methods:
Data from 244 allograft recipients were analyzed. Known factors affecting CAV and mean HR obtained from 24-hour recordings at 1 year (dichotomized at ≥90 beats/min) were tested in univariate and multivariable Cox analysis.
Results:
During a median of 96 months, 60 patients (25%) experienced CAV. Surprisingly, HR < 90 but not ≥90 beats/min was significantly associated with an increased CAV development. Univariate analysis showed several predictors were associated with the end point; however, at multivariable analysis, only donor's age, chronic renal failure, and left ventricular end-diastolic wall thickness were significant predictors of CAV, with hazard ratios of 1.02 (95% confidence interval, 1.00-1.04), 1.90 (1.13-3.21), and 1.11 (1.00-1.22), respectively. A highly statistically significant difference in donor's age was found among patients with mean heart rate ≥90 or <90 beats/min (30 ± 13 vs 40 ± 14 years, p < 0.0001).
Conclusions:
In the denervated heart, sinus tachycardia is not a risk factor for coronary atherosclerosis. HR in heart transplant recipients reflects "intrinsic heart rate" and is a simple epiphenomenon of the donor's age.
