Left atrial peak reservoir strain and outcomes after heart transplantation
S Jeong, Y Yang, J Hyun, S E LeeAbstract
Background
Left atrial (LA) strain has been proposed as a noninvasive surrogate of left ventricular (LV) filling pressure and diastolic function. Although its prognostic relevance has been demonstrated across various cardiovascular conditions, evidence in heart transplant (HTx) recipients remains limited.
Objectives
The prognostic value of LA peak reservoir strain (LARS) in adult cardiac allograft recipient was investigated.
Methods
This was a single-center observational cohort study of adult HTx recipients who underwent coronary angiography with invasive LV end-diastolic pressure (LVEDP) assessment and transthoracic echocardiography between January 2018 and December 2021. The primary endpoint was graft survival, defined as a composite of re-transplantation or all-cause mortality. The recipients with LARS ≤11.2% wereas categorized as low-LARS group.
Results
Among 133 patients included, 16 (12.0%) exhibited low LARS. LARS demonstrated a significant inverse correlation with LVEDP (r = −0.269, p = 0.002). Over a median follow-up of 1,580 days, 15 patients (11.3%) reached the primary endpoint. Patients with low LARS showed significantly reduced graft survival compared with those with preserved LARS (log-rank p <0.001). In multivariable Cox proportional regression analysis, low LARS was independently associated with a higher risk of graft loss (hazard ratio 5.77, 95% confidence interval 1.50–22.22, p = 0.011). These findings remained consistent after propensity score matching (32 high- vs. 16 low-LARS patients) and across sensitivity analyses.
Conclusions
Reduced LARS is associated with elevated LV filling pressures and independently predicts adverse graft outcomes after HTx. LARS may provide a useful noninvasive tool for risk stratification in heart transplant recipients.Correlation between LVEDP and LARSFor image description, please refer to the figure legend and surrounding text.Event-free survival by LARSFor image description, please refer to the figure legend and surrounding text.