Reduced left atrial compliance exacerbates primary graft dysfunction after lung transplantation

Area of Science:

• Cardiology
• Thoracic Surgery
• Transplantation Medicine

Background:

• Primary graft dysfunction (PGD) significantly impacts lung transplantation (LTx) outcomes.
• Pre-existing left ventricular diastolic dysfunction in recipients increases PGD risk.
• Left atrial strain (LAS) is a sensitive marker for left atrial compliance.

Purpose of the Study:

• To investigate the predictive role of preoperative left atrial strain (LAS) for PGD after bilateral lung transplantation (LTx).
• To assess LAS as a potential biomarker for PGD risk stratification.

Main Methods:

• Analysis of preoperative echocardiograms for LAS (reservoir, conduit, pump) and left ventricular global longitudinal strain (LV GLS) in 132 LTx patients.
• Correlation of strain indices with PGD grade 3 occurrence (defined as P:F <200 at 48/72 hours).
• Univariable and multivariable analyses including right heart catheterization data to identify PGD predictors.

Main Results:

• No significant differences in traditional left ventricular diastolic dysfunction markers between PGD (+) and PGD (-) groups.
• Patients who developed PGD showed reduced reservoir LAS, conduit LAS, and LV GLS.
• Multivariable analysis identified reduced conduit LAS and increased pulmonary vascular resistance as independent predictors of PGD.

Conclusions:

• Decreased preoperative left atrial compliance, indicated by reduced LAS, is associated with a higher risk of PGD in LTx recipients with normal LV function.
• LAS should be considered a valuable risk factor for PGD in future prospective studies.