Early left ventricular systolic function is a more sensitive predictor of adverse events after heart transplant

Abstract

Background First-phase ejection fraction (EF1) is a novel measure of early systolic function. This study was to investigate the prognostic value of EF1 in heart transplant recipients.

Methods Heart transplant recipients were prospectively recruited at the Union Hospital, Wuhan, China between January 2015 and December 2019. All patients underwent clinical examination, biochemistry measures [brain natriuretic peptide (BNP) and creatinine] and transthoracic echocardiography. The primary endpoint was a combined event of all-cause mortality and graft rejection.

Results In 277 patients (aged 48.6±12.5 years) followed for a median of 38.7 (interquartile range: 18.3) months, there were 35 (12.6%) patients had adverse events including 20 deaths and 15 rejections. EF1 was negatively associated with BNP (β=-0.220, p<0.001) and was significantly lower in patients with events compared to those without. EF1 had the largest area under the curve in ROC analysis compared to other measures. An optimal cut-off value of 25.8% for EF1 had a sensitivity of 96.3% and a specificity of 97.1% for prediction of events. EF1 was the most powerful predictor of events with hazard ratio per 1% change in EF1: 0.628 (95%CI: 0.555-0.710, p<0.001) after adjustment for left ventricular ejection fraction and global longitudinal strain.

Conclusions Early left ventricular systolic function as measured by EF1 is a powerful predictor of adverse outcomes after heart transplant. EF1 may be useful in risk stratification and management of heart transplant recipients.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

We acknowledge the financial support from the National Natural Science Foundation of China (grant 81922033 to Li Zhang; grant 81727805 to MX; and grant 81701716 to ZS) and National Institute for Health Research, UK (ICA-CL-2018-04-ST2-012) to HG and by British Heart Foundation, UK (PG/19/23/34259) to HG.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the Union Hospital Tongji Medical College Ethical committee and complied with the Declaration of Helsinki.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Yes

Footnotes

* Co-first author

† Co-senior author

Data Availability

The data that support the findings of this study are available on request from the corresponding author.

AbbreviationsBSABody surface areaBNPBrain natriuretic peptideCVcoefficient of variationEF1First-phase ejection fractionEFEjection fractionEDVEnd-diastolic volumeESVEnd-systole volumeHTHeart transplant StrokeLAVLeft atrial volumeLAViLeft atrial volume indexLVLeft ventricularLVGLSLeft ventricular global longitudinal strainRVRight ventricularRVFACRight ventricular fractional area changeSVStroke volumeSViStroke volume indexTAPSETricuspid annular plane systolic excursionTPAVFTime of peak aortic valve flow velocity

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