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Afterload Mismatch Is Associated With Higher Cardiac Mortality After Heart Transplantation
Mattia Corianò1, Nicola Pradegan2, Andrea Golfetto1
1Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy.
Journal of the American Heart Association
|September 25, 2025
Summary
After heart transplant (HT), afterload mismatch (AM) is identified as an independent predictor of cardiac mortality. This study defines AM phenotypes and their impact on long-term survival in HT recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Physiology
Background:
- Heart transplant (HT) recipients often exhibit altered ventricular-arterial interactions.
- The prognostic significance of these physiological changes, specifically afterload mismatch (AM), remains incompletely understood.
- This study investigates AM in HT patients to clarify its determinants and long-term cardiac mortality implications.
Purpose of the Study:
- To identify the presence and characteristics of afterload mismatch (AM) in heart transplant recipients.
- To determine the factors contributing to the development of AM post-transplantation.
- To assess the impact of AM on long-term cardiac mortality in this patient cohort.
Main Methods:
- An observational, single-center study analyzed a historical cohort of heart transplant (HT) recipients.
- Patients with preserved ejection fraction and minimal rejection/vasculopathy were included.
- Arterial and ventricular elastance were noninvasively calculated to classify patients into low afterload (LA), matched high afterload (MHA), and afterload mismatch (AM) groups.
Main Results:
- Afterload mismatch (AM) was associated with lower left ventricular ejection fraction and stroke volume compared to other groups.
- Predictors of AM included male recipient/male donor and male recipient/female donor combinations.
- AM was identified as an independent predictor of increased cardiac mortality, with significantly lower median survival (17.2 years) compared to LA and MHA groups.
Conclusions:
- Three distinct phenotypes were identified in heart transplant recipients based on ventricular-arterial interactions.
- Afterload mismatch (AM) emerged as a significant independent predictor of long-term cardiac mortality.
- These findings highlight the clinical importance of assessing ventricular-arterial coupling in heart transplant management.
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