Related Experiment Video
Updated: Feb 17, 2026
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Incremental Value of Deformation Imaging and Hemodynamics Following Heart Transplantation: Insights From
Yukari Kobayashi1, Naga Lakshmi Sudini1, June-Wha Rhee1
1Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California; Stanford Cardiovascular Institute, Stanford, California.
Insights
Right atrial pressure and left ventricular global longitudinal strain after heart transplantation predict long-term outcomes. These key graft function markers help assess patient prognosis and guide post-transplant care.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Diagnostics
Background:
- Graft failure is a significant cause of late mortality following heart transplantation (HT).
- Limited research exists on the prognostic value of graft dysfunction identified early after HT.
Purpose of the Study:
- To define graft dysfunction after heart transplantation.
- To determine the association between graft dysfunction and long-term outcomes.
- To explore the prognostic value of graft dysfunction at 1- and 5-year follow-ups.
Main Methods:
- Included 215 heart transplant recipients with annual evaluations including right heart catheterization and echocardiography.
- Utilized hierarchical clustering to identify functional modules of graft dysfunction.
- Primary endpoint: composite of cardiovascular mortality, re-transplantation, or heart failure hospitalization within 5 years; secondary endpoint: 10-year all-cause mortality.
Main Results:
- Identified left ventricular global longitudinal strain (LVGLS), stroke volume index, and right atrial pressure (RAP) as key indicators of graft function.
- Graft dysfunction was present in a significant proportion of patients based on defined thresholds for LVGLS, stroke volume index, and RAP/pulmonary capillary wedge pressure.
- Multivariate analysis revealed RAP, LVGLS, and history of rejection within 1 year as independent predictors of 5-year outcomes. RAP at 5 years and its change from 1 to 5 years predicted 10-year mortality.
Conclusions:
- Right atrial pressure (RAP) and left ventricular global longitudinal strain (LVGLS) at the first annual evaluation offer complementary prognostic information.
- These parameters are valuable in predicting 5-year outcomes after heart transplantation.
- Changes in RAP over time also correlate with long-term survival.
Objectives:
This study investigated to define graft dysfunction and to determine its incremental association with long-term outcome after heart transplantation (HT).
Background:
Although graft failure is an established cause of late mortality after HT, few studies have analyzed the prognostic value of graft dysfunction at 1- and 5-year follow-up of HT.
Methods:
Patients who underwent HT and completed their first annual evaluation with right heart catheterization and echocardiography at Stanford University between January 1999 and December 2011 were included in the study. Hierarchical clustering was used to identify modules to capture independent features of graft dysfunction at 1 year. The primary endpoint for analysis consisted of the composite of cardiovascular mortality, re-transplantation, or heart failure hospitalization within 5 years of HT. The study further explored whether changes in graft dysfunction between 1 and 5 years were associated with 10-year all-cause mortality.
Results:
A total of 215 HT recipients were included in the study. Using hierarchical clustering, 3 functional modules were identified; among them, left ventricular global longitudinal strain (LVGLS), stroke volume index, and right atrial pressure (RAP) or pulmonary capillary wedge pressure (PCWP) captured key features of graft function. Graft dysfunction based on pre defined LVGLS in absolute value <14%, stroke volume index <35 ml/m2, RAP >10 mm Hg, or PCWP >15 mm Hg were present in 41%, 36%, and 27%, respectively. The primary endpoint at 5 years occurred in 52 patients (24%), whereas 10-year all-cause mortality occurred in 30 (27%) of 110 patients alive at 5 years. On multivariate analysis, RAP (standardized hazard ratio: 1.63), LVGLS (standardized hazard ratio: 1.39), and a history of hemodynamically compromising rejection within 1 year (hazard ratio: 2.18) were independent predictors of 5-year outcome. RAP at 5 years, as well as change in RAP from 1 to 5 years, was predictive of 10-year all-cause mortality.
Conclusions:
RAP and LVGLS at the first annual evaluation provide complementary prognostic information in predicting 5-year outcome after HT.
