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Predictors of cardiac allograft vasculopathy and dysfunction in heart transplantation: a single-center study
Session:
SESSÃO DE POSTERS 22 - LVAD / TRANSPLANTAÇÃO CARDÍACA
Speaker:
Rita Almeida Carvalho
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Rita Almeida Carvalho; Ana Rita Bello; Márcia Presume; Sérgio Maltês; Bruno Rocha; Gonçalo Cunha; Sara Ranchordas; Catarina Brízido; Christopher Strong; Marta Marques; Carlos Aguiar
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> Heart transplantation (HT) is the gold-standard treatment for selected patients with advanced heart failure. However, long-term outcomes may be significantly influenced by complications, particularly cardiac allograft vasculopathy (CAV) and late graft dysfunction (LGD). We aimed to evaluate the predictors of CAV and LGD following HT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong>: Retrospective single-center cohort study including all patients who underwent orthotopic heart transplantation between 2019 and 2023. Post-HT monitoring included endomyocardial biopsies (EMBs) to detect acute rejection, as well as blood tests to assess renal function and cardiac biomarkers at predefined intervals (1, 2, 3, 4, 6, 8, and 12 weeks; 4, 6, 8, 10, and 12 months). CAV was assessed by coronary angiography or cardiac CT and patients were classified as per the ISHLT Guidelines into CAV score 0-1 and score <span style="font-family:"Arial",sans-serif">≥</span>2. LGD was evaluated by transthoracic echocardiography and defined as left ventricular ejection fraction (LVEF) <55%. CAV and LGD were assessed at 1-year post-HT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong>The study included 57 patients (mean age 51±11 years; 74% male). During the first year post-HT, cardiovascular risk factors were prevalent, including dyslipidemia (60%), diabetes mellitus (44%) and hypertension (40%). Among 595 EMBs, there were 54 (9%) rejection episodes in 25 (44%) patients, comprising of 18 acute cellular rejections (ACR) in 13 patients and 36 antibody-mediated rejections (AMR) in 16 patients. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At 1-year post-HT, 6 patients (11%) had moderate-to-severe (ISHLT<span style="font-family:"Arial",sans-serif">≥</span>2) CAV. These were all male (100% <em>vs.</em> 34%, p=0.076) with a higher prevalence of cardiovascular risk factors [e.g., hypertension (83% <em>vs.</em> 36%, p=0.030), higher median total cholesterol (188±25 <em>vs.</em> 163±25 mg/dL, p=0.028), with a trend towards more patients with type 2 diabetes mellitus (83 <em>vs.</em> 42%, p=0.058)] and renal dysfunction (mean creatinine 1.5±0.5 <em>vs</em>. 1.1±0.3 mg/dL, p=0.025). Half of the patients with CAV experienced AMR episodes beyond the first month post-HT (50% <em>vs.</em> 17%, p=0.065). There were no differences in cardiac biomarkers or ACR episodes between CAV 0-1 vs. score <span style="font-family:"Arial",sans-serif">≥</span>2.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At 1-year post-HT, the mean LVEF was 58 ± 5%. LGD was identified in 12 patients (21%). These patients were older (mean age 55±49 years, p=0.082) and had a higher body mass index (27±3 <em>vs.</em> 24±4 kg/m<sup>2</sup>, p=0.044). One in every three patients with LGD experienced ACR episodes beyond the first month post-HT (33% <em>vs</em>. 6%, p=0.015). We found no differences in cardiac biomarkers levels or AMR episodes between patients with and without LGD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong>: In a contemporary cohort of HT patients, CAV was associated with sex (male), traditional cardiovascular risk factors and AMR episodes, and LGD was associated with age (older), body mass index (higher) and ACR episodes (Figure 1), thus reproducing older studies. These findings underscore that both non-modifiable and potentially modifiable markers may associate with CAV and LGD.</span></span></p>
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