SPC365

Predictors of Acute Heart Transplant Rejection

Session: Comunicações Orais - Sessão 01 - Choque cardiogénico e transplante cardíaco
Speaker: Miguel Eduardo Caramelo Abrantes de Figueiredo

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.6 Acute Heart Failure - Clinical
Session Type: Comunicações Orais
FP Number: ---
Authors: Miguel Abrantes De Figueiredo; Francisco Albuquerque; Ana Raquel Santos; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Rui Soares; Lídia de Sousa; Valdemar Gomes; Pedro Coelho; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> In patients submitted to heart transplant (HT), endomyocardial biopsy (EMB) is considered the most accurate measure for acute cellular rejection (ACR). Invasive hemodynamic parameters obtained during right-heart catheterization are well established predictors of ACR. However, the ability of clinical and non-invasive parameters accurately predict ACR is not yet well defined.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Objective:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> To evaluate the accuracy of invasive and non-invasive analytical, electrocardiographic (ECG) and echocardiographic parameters in detecting significant ACR in HT patients.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Retrospective analysis of 249 consecutive EMB samples of HT patients between February 2016 and November 2023 from one tertiary care center in Portugal. Additionally, data from same-day blood analysis, ECG and the most recent transthoracic echocardiography (TTE) were also collected. Significant ACR was defined as &ge; 2R on EMB (according to the International Society of Heart and Lung Transplantation 2004 grading) or if high-dose immunosuppressants were prescribed. Independent-samples t-test and chi-square were used to identify statistical significance between the invasive and non-invasive parameters and significant ACR. For the statistically significant parameters, receiver operating characteristic (ROC) curves, area under the curve (AUC) and their optimal point were calculated.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Three EMB samples were excluded due to insufficient material for histopathological analysis. Significant ACR was present in 10.6% of cases. Cardiac index, pulmonary capillary wedge pressure, central venous pressure (CVP), cardiac power output, right ventricular (RV) pressures, pulmonary artery pressures and pulmonary artery pressure index are invasive parameters associated with significant ACR (p-value &lt; 0.05). Left ventricular ejection fraction and estimated systolic pulmonary arterial pressure in the TTE, abnormal rhythm and axis in the ECG are non-invasive parameters associated with significant ACR. ROC curve results are portrayed in Table 1. Based on the ROC curves, CVP (AUC = 0.855) and RV end-diastolic pressure (AUC = 0.811) are the best predictors of ACR.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Significant ACR was present in 10.6% of cases. Hemodynamic right-heart catheterization parameters were closely correlated with ACR. Moreover, non-invasive analytical, ECG and TTE parameters were also correlated with significant ACR in HT patients, allowing its use as a predictor in clinical practice.</span></span></span></span></p>