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Updated: Jun 12, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Impact of Left Ventricular-Vascular Interaction on Long-Term Outcome After Heart Transplantation
Mattia Corianò1, Nicola Pradegan2, Andrea Golfetto1
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital Padua, Padua, Italy.
Insights
High arterial elastance (Ea) and low left ventricular end-systolic elastance (Ees) in heart transplant (HT) recipients are linked to worse long-term outcomes. These pressure-volume derivative variables predict mortality risk in HT survivors with preserved ejection fraction.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Physiology
Background:
- Heart transplantation (HT) is a life-saving procedure for end-stage heart failure.
- Assessing long-term outcomes in HT recipients with preserved ejection fraction is crucial.
- Pressure-volume (PV) derivative variables offer insights into cardiovascular function post-transplantation.
Purpose of the Study:
- To compare PV derivative variables between HT recipients and healthy controls.
- To evaluate the impact of these variables on long-term cardiovascular mortality.
- To identify predictors of adverse outcomes in stable HT survivors.
Main Methods:
- Retrospective analysis of 345 HT patients surviving the first post-transplant year with LVEF ≥50%.
- Measurement of arterial elastance (Ea) and left ventricular end-systolic elastance (Ees) using transthoracic echocardiography.
- Comparison of PV variables with healthy controls and assessment of cardiovascular mortality over a median 11.3-year follow-up.
Main Results:
- HT recipients exhibited higher Ea and Ees compared to controls (p < 0.0001 for both).
- Ventricular arterial coupling (VAC) was similar between groups (p = 0.105).
- High Ea (> 4 mmHg/mL/m²) and low Ees (≤ 6.75 mmHg/mL/m²) were independently associated with increased mortality risk (HR 2.25 and 3.70, respectively).
Conclusions:
- In HT recipients with preserved LVEF one year post-transplant, elevated Ea and reduced Ees are significant predictors of long-term adverse outcomes.
- These findings highlight the prognostic value of PV derivative variables in managing HT patients.
- Targeting or monitoring these parameters may improve long-term cardiovascular outcomes in heart transplant recipients.
Background And Aim:
To compare pressure-volume (PV) derivative variables between HT patients and healthy controls and to assess their impact on long-term outcome.
Methods:
In this single-center retrospective study, HT patients surviving their first post-HT year with left ventricular ejection fraction (LVEF) ≥50%, absence of allograft vasculopathy, and rejection were enrolled. PV variable surrogates were measured by transthoracic echocardiography and compared with healthy controls. The endpoint was cardiovascular mortality.
Results:
From 1985 to 2015, 345 patients were enrolled. Arterial elastance (Ea) and left ventricular end-systolic elastance (Ees) were higher in HT recipients than in healthy controls (4.03 vs. 1.65, p < 0.0001 and 6.75 vs. 2.47, p < 0.0001, respectively), while ventricular arterial coupling (VAC) was similar between the two groups (0.66 vs. 0.59, p = 0.105). After a median of 11.3-year follow-up, 59 (17%) HT recipients died. VAC was not significantly associated with cardiac mortality (p = 0.074). Survival was lower in HT recipients with Ea > 4 mmHg/mL/m2 and Ees ≤ 6.75 mmHg/mL/m2, and both were independently associated with mortality risk after adjustment (Ea > 4 mmHg/mL/m2: HR 2.25 [95% CI 1.38-3.66], p = 0.013; Ees ≤ 6.75 mmHg/mL/m2: HR 3.70 [95% CI 1.95-7.06], p = 0.001).
Conclusions:
In HT recipients surviving the first year after transplantation with normal LVEF, high Ea, and low Ees values were independently associated with poorer outcomes in long-term follow-up.
