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• W4386914529 abstract "Pulmonary hypertension (PH) can cause left ventricular diastolic dysfunction (DD) through ventricular interdependence. Moreover, DD has been linked with adverse outcomes after lung transplant (LTx). The impact of LTx on DD in recipients with pre-transplant PH is not defined. In this cohort, we aimed to assess the prevalence of DD, change in DD after LTx and the impact of DD on LTx outcomes.In a large, single center database from January 2011-September 2021, single or bilateral LTx recipients with PH (mean pulmonary artery pressure (mPAP)>20mmHg) were retrospectively identified. Those without a pre- or post-transplant echocardiogram within 1 year were excluded. DD was diagnosed and graded according to the American Society of Echocardiography 2016 guideline on assessment of DD (present, absent, indeterminate). McNemar's test was used to examine association between DD pre- and post-transplant. Kaplan Meier and Cox regression analysis were used to assess associations between pre-LTx DD and post LTx 1-year outcomes including mortality, major adverse cardiac events (MACE) and bronchiolitis obliterans syndrome grade 1 or higher (BOS) free survival.Of 476 primary LTx recipients, 205 with PH formed the study cohort (mean age 56.6 +/- 11.9, men 61.5%, mPAP 30.5 +/- 9.8 mmHg, LVEF < 55% 9 (4.3%)). Pre-transplant, DD was present in 93 (45.4%) (Grade I=8, II=84, III=1), absent in 16 (7.8%), indeterminate in 89 (43.4%), and 7 (3.4%) had missing data. Post-transplant, DD was present in 7 (3.4%) (Grade I=2, II=5, III=0), absent in 164 (80.0%), indeterminate in 15 (7.3%), and 19 (9.3%) had missing data. For those with DD grades in both time periods (n=180), there was a significant decrease in DD post-transplant (148 of 169 patients with resolved DD; McNemar's test p<0.001). Pre-transplant DD was not associated with MACE (HR 1.08, 95%CI 0.72-1.62; p=0.71), BOS-free survival (HR 0.67, 95% CI 0.39-1.56; p=0.15) or mortality (HR 0.70, 95% CI 0.33-1.46; p=0.34) at 1-year.DD is highly prevalent in LTx candidates with normal left ventricular systolic function and PH and resolves in most patients after LTx regardless of patient characteristics. Pre-LTx DD was not associated with adverse lung or cardiac outcomes after LTx. Collectively, these findings suggest that the presence of DD in LTx recipients with PH has no prognostic significance, and as such DD and the associated clinical syndrome of heart failure with preserved ejection fraction should not be considered a relative contraindication to LTx in such patients." @default.
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• W4386914529 date "2023-09-01" @default.
• W4386914529 modified "2023-09-30" @default.
• W4386914529 title "Impact of Lung Transplantation on Diastolic Dysfunction in Recipients with Pre-Transplant Pulmonary Hypertension" @default.
• W4386914529 doi "https://doi.org/10.1016/j.jtcvs.2023.09.031" @default.
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