Impact of Hemodynamic Parameters on Outcomes in European Heart Transplant Patients/Results from the Eurotransplant Database

Abstract

<h3>Purpose</h3> Patients with end stage heart failure frequently suffer from pulmonary hypertension (PH). The transpulmonary pressure gradient (TPG) is traditionally used to estimate the impact of pulmonary hypertension on outcome. Guidelines recommend diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) to differentiate isolated post - from combined pre - and postcapillary PH. We evaluated the predictive power of DPG, PVR and Pulmonary pulsatility index (PAPi, defined as [(systolic pulmonary artery pressure - diastolic pulmonary artery pressure)/central venous pressure]) on graft failure and overall outcome of transplant patients in an European cohort. <h3>Methods</h3> The Eurotransplant database was queried to identify patients undergoing heart transplantation between 2009 and 2019 (n=10,465), had hemodynamic evidence of PH (PAPm >25 mmHg) and hemodynamic data generated by right heart catheter. We investigated these data regarding graft failure and outcome. <h3>Results</h3> In patients with the above mentioned criteria (n = 1407) the median PVR was 2.5 WU (IQR 1.6 WU) with a median PAPm (pulmonary arterial pressure) of 32 mmHg (IQR 9 mmHg), a mean PAWP (pulmonary artery wedge pressure) of 24 mmHg (IQR 9 mmHg), median TPG of 8 mmHg (IQR 6 mmHg), median DPG 0 mmHg (IQR 5 mmHg) and median PAPi of 1.8 (IQR 1.7). While patients with low (<3 mmHg) DPG had a better 5 year survival than those with higher DPG (log rank p=0.023, median survival 1556 vs. 1318 days), there was no difference in survival in patients with low vs. high TPG, PAPm, PAPi and PVR (table attached). Low PAPi (AUC 0.62, p<0.001) and high PVR (AUC 0.60, p<0.001) were associated with graft failure. <h3>Conclusion</h3> A high DPG is associated with survival after heart transplantation, confirming its usefulness for pre-transplant assessment of patients with heart failure and pulmonary hypertension. In addition, a low PAPi and a high PVR identified patients at risk of graft failure in patients with PH undergoing heart transplantation.