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Increased Pre-Transplant Carotid Intima-Media Thickness Is Associated with Early Post-Transplant Atrial Fibrillation,
Karsten M Heil1, Rasmus Rivinius1, Matthias Helmschrott1
1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Insights
Increased carotid intima-media thickness (CIMT) before heart transplantation (HTX) predicts worse outcomes. Patients with CIMT > 0.9 mm face higher mortality, graft failure, and stroke risks post-HTX.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Carotid intima-media thickness (CIMT) is a known cardiovascular risk factor in the general population.
- The prognostic value of pre-transplant CIMT in heart transplant recipients (HTX) is not well-established.
- This study examines the impact of elevated pre-transplant CIMT on HTX outcomes.
Purpose of the Study:
- To investigate the association between increased pre-transplant CIMT (>0.9 mm) and post-heart transplantation outcomes.
- To identify pre-transplant CIMT as a potential risk stratification marker for HTX patients.
- To evaluate the influence of pre-transplant CIMT on mortality, graft failure, atrial fibrillation, and stroke after HTX.
Main Methods:
- Retrospective analysis of 311 HTX patients from 2002-2014 at a single center.
- Stratification of patients based on pre-transplant CIMT: ≤0.9 mm versus >0.9 mm.
- Assessment of donor/recipient demographics, medications, mortality causes, early atrial fibrillation (AF), and stroke.
Main Results:
- 11.9% of HTX recipients had pre-transplant CIMT > 0.9 mm.
- These patients exhibited significantly higher 10-year mortality (81.1% vs. 41.2%), graft failure deaths (24.3% vs. 10.6%), and thromboembolic/bleeding deaths (10.8% vs. 2.9%).
- Pre-transplant CIMT > 0.9 mm independently predicted 10-year mortality (HR: 2.599) and was linked to higher rates of early AF (27.0% vs. 10.9%) and stroke (10.8% vs. 1.1%).
Conclusions:
- Pre-transplant CIMT > 0.9 mm serves as a significant prognostic marker after heart transplantation.
- Elevated CIMT is associated with increased early post-transplant AF, stroke, and reduced long-term survival.
- High-risk patients warrant intensified cardiovascular risk factor management and close monitoring post-HTX.
Background:
Carotid intima-media thickness (CIMT) is an established risk factor for adverse cardiovascular events in the general population, but its impact on patients after heart transplantation (HTX) remains unknown. We investigated the effects of an increased pre-transplant CIMT > 0.9 mm on outcomes after HTX.
Methods:
This observational retrospective single-center study included 311 patients receiving HTX at Heidelberg Heart Center between 2002 and 2014. Patients were stratified by degree of pre-transplant CIMT (CIMT ≤ or >0.9 mm, threshold defined by ESC guidelines). Analysis covered donor and recipient demographics, post-transplant medications, mortality (including causes of death after HTX), early post-transplant atrial fibrillation (AF), and stroke after HTX.
Results:
A total of 37 of 311 HTX recipients (11.9%) had a pre-transplant CIMT > 0.9 mm. These patients showed an increased 10-year post-transplant mortality (81.1% versus 41.2%, p < 0.001) and had a higher percentage of death due to graft failure (24.3% versus 10.6%, p = 0.017), as well as due to thromboembolic events/bleeding (10.8% versus 2.9%, p = 0.019). Multivariate analysis demonstrated pre-transplant CIMT > 0.9 mm as an independent risk factor for 10-year mortality after HTX (HR: 2.599, 95% CI: 1.683-4.014, p < 0.001). Secondary outcomes showed a significantly higher rate of 30-day post-transplant AF (27.0% versus 10.9%, p = 0.006) and 30-day stroke after HTX (10.8% versus 1.1%, p < 0.001) in patients with a pre-transplant CIMT > 0.9 mm.
Conclusion:
Pre-transplant CIMT > 0.9 mm is a prognostic marker for early post-transplant AF, stroke, and reduced long-term survival after HTX. Preventive measures, including close monitoring and management of cardiovascular risk factors, are warranted in these high-risk patients.
