Invasive aortic pulse pressure is linked to cardiac allograft vasculopathy after heart transplantation

Area of Science:

• Cardiovascular Medicine
• Transplantation Immunology
• Vascular Biology

Background:

• Pulse pressure (PP) is associated with increased coronary atherosclerosis and cardiovascular event risk.
• Cardiac allograft vasculopathy (CAV) is a major cause of graft failure and mortality after heart transplantation (HTx).
• The role of aortic PP in CAV progression and long-term cardiovascular outcomes post-HTx requires further investigation.

Purpose of the Study:

• To determine the association between aortic PP and CAV progression in HTx recipients.
• To evaluate the predictive value of aortic PP for major adverse cardiovascular events (MACE) after HTx.
• To identify independent determinants of CAV progression and MACE in the post-HTx population.

Main Methods:

• A cohort of 330 HTx patients underwent serial coronary intravascular ultrasound (IVUS) and invasive aortic PP measurements.
• CAV progression was quantified by IVUS-derived changes in plaque volume (ΔPV/SL) over a median of 3.99 years.
• MACE included mortality, myocardial infarction, revascularization, heart failure hospitalization, or re-transplantation over 12 years.

Main Results:

• High aortic PP (≥ 50 mmHg) was an independent predictor of CAV progression (OR, 1.72; P=0.045).
• Both high aortic PP (HR, 1.46; P=0.044) and high baseline CAV grade (HR, 1.50; P=0.037) were independently associated with MACE.
• Recipient age, sex, and renal dysfunction independently determined high aortic PP.

Conclusions:

• High aortic PP is significantly associated with plaque progression in post-HTx patients.
• Aortic PP and CAV grade are independent predictors of long-term MACE after heart transplantation.
• Arterial stiffness, reflected by aortic PP, and CAV severity are crucial for predicting MACE in HTx recipients.