Title : Left atrioventricular coupling index as a novel prognostic marker of adverse events in heart transplant patients
Abstract:
Purpose: Decreased diastolic(DD) function may be one of the early manifestations of acute rejection after heart transplantation. Left atrioventricular coupling index (LACl) is associated with DD severity. The purpose of this study was to investigate the novel prognostic value of LACl assessed by echocardiography, to predict adverse events in heart transplant patients.
Materials and methods: A single-center retrospective study of echocardiography was conducted. Clinical and echocardiographic features were analyzed. The primary outcome was all cause death or confirmed rejection. Diastolic function was graded using the American Society of Echocardiography (ASE)/European Association of Cardiovascular lmaging (EACVl) algorithm for patients. LACl was defined as the ratio between LAVmin and LVEDV. LA and LV volumes were measured in the same end-diastolic phase defined by the mitral valve closure. The multivariate Cox hazard model was performed to identify the independent predictors of LACI for adverse clinical events in HT recipients. And receiver operating characteristic (ROC) curves were performed to identify their best cutoff values.
Results: A total of 95 patients after HT were included in the study, the composite of adverse clinical events occurred in 45 patients. The HT patients with adverse events showed significantly larger LACI than patients without adverse events (0.56(0.55,0.61) vs 0.39 (0.37,0.40), P < 0.001), which was larger then the healthy control subjects(0.56(0.55,0.61) vs 0.08 (0.05,0.11), P < 0.001). On multivariable analysis, LACl was independently associated with outcomes (hazard ratio, HR=3.870, 95%CI:1.506-9.949, P=0.005) to predict cardiovascular events. A cutoff value of >0.53 identified adverse events with an area under the curve of 0.90.
Conclusions: LACl measured by echocardiography is a novel independently prognostic marker associated with adverse events in heart transplant patients.
Keywords: Echocardiography, Heart transplantation, Adverse outcome, Left atrioventricular coupling index, Decreased diastolic function.
