Impact of preoperative left ventricular diastolic dysfunction on primary graft dysfunction and mortality following...

Lung transplantation (LTx) is a definitive treatment for end-stage lung disease, yet primary graft dysfunction (PGD) remains a major cause of early postoperative morbidity and mortality. Left ventricular diastolic dysfunction (LVDD) is common in these patients, but its impact on PGD and survival remains unclear. This study aimed to determine whether preoperative LVDD increases the risk of PGD and 1-year mortality after LTx.

A retrospective cohort study was conducted, involving 344 patients who underwent LTx in Wuxi People's Hospital from January 1, 2018, to June 22, 2021. Regression models were utilized to examine the effects of LVDD and transthoracic echocardiography (TTE) parameters on PGD or 1-year mortality risk. The predictive performance of various cardiac indicators for PGD was evaluated using the area under the curve (AUC).

LVDD [odds ratio (OR) 2.099, 95% confidence interval (CI) 1.071-4.116, P=0.03] and e'<10 cm/s (OR 2.139, 95% CI: 1.177-3.889, P=0.01) were independently associated with a higher risk of PGD. In multivariate analysis, LVDD was not associated with higher 1-year mortality risk (hazard ratio 1.638, 95% CI: 1.129-2.375, P=0.009). The clinical threshold for e' to predict PGD was determined to be 9.85 cm/s, with a sensitivity of 67% and specificity of 48%.

Preoperative LVDD significantly increases the risk of PGD following LTx. LVDD was not an independent risk factor for postoperative 1-year mortality. Future prospective clinical studies are required to validate LVDD as a risk factor for post-LTx PGD and to further investigate whether LVDD impacts mortality through mediator effects.