Left Ventricular Physiology and Ventricular‐Vascular Interactions in Young Patients After Heart Transplantation

Abstract

Background In patients after heart transplantation, systemic arterial hypertension and enhanced central aortic stiffness contribute to increased ventricular afterload, which might lead to graft dysfunction. The aim of our study was to characterize systemic arterial elastance and its impact on left ventricular function and ventriculo‐arterial coupling in a cohort of children, adolescents, and young adults after heart transplantation using invasive conductance catheter technique. Methods and Results Thirty patients who had heart transplants (age, 20.0±6.5 years, 7 female) underwent invasive cardiac catheterization including pressure‐volume loop analysis. Load‐independent parameters of systolic (ventricular elastance [Ees]) and diastolic (ventricular compliance) function as well as systemic arterial elastance (Ea, end‐systolic pressure/stroke volume) and ventriculo‐arterial coupling (Ea/Ees) were assessed at baseline level and during dobutamine infusion (10 μg/kg/min). Ees showed an appropriate increase under inotropic stimulation from 0.43 (0.11–2.52) to 1.00 (0.20–5.10) mm Hg/mL/m 2 ( P <0.0001), whereas ventricular compliance remained rather unchanged (0.16±0.10 mm Hg/mL/m 2 to 0.12±0.07 mm Hg/mL/m 2 ; P =0.10). Ventriculo‐arterial coupling Ea/Ees was abnormal at rest and did not improve significantly under dobutamine (1.7 [0.6–6.7] to 1.3 [0.5–4.9], P =0.70) due to a simultaneous rise in Ea from 0.71 (0.37–2.82) to 1.10 (0.52–4.03) mm Hg/mL/m 2 ( P <0.0001). Both Ees and ventricular compliance were significantly associated with Ea at baseline and under dobutamine infusion. Conclusions Patients who underwent heart transplantation show impaired ventriculo‐arterial coupling at rest and under inotropic stimulation despite preserved left ventricular contractile reserve. An abnormal response in vascular function resulting in increased afterload seems to represent an important factor that may play a role for the development of late graft failure.

Aortic pulse wave analysis and functional capacity of heart transplantation candidates: a pilot study

“…These authors observed that patients submitted to heart transplantation present impaired ventricular-arterial coupling at rest and in response to inotropic stimulation, despite having preserved left ventricular contractile reserve. An abnormal response in vascular function leading to an increase in afterload appears to be a significant factor that may play a role in the development of late graft failure 35 .…”

Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops

“…Studies have shown that adults with rToF or ASD have diminished endothelial function ( Scicchitano et al, 2019 ; Goeder et al, 2022 ). Patients after heart-transplantation also have increased arterial elastance which has been proposed to play a role in late graft failure ( Latus et al, 2023 ) but the prognostic value has not to our knowledge been studied in patients with ASD or rToF. It is however shown that patients with non-complex CHD have an increased risk of cardiovascular disease, disproportionate to the burden of other known risk factors ( Saha et al, 2019 ).…”