The Role of Transpulmonary Gradient and Mean Pulmonary Artery Pressure in Risk Stratification of Heart Transplant Candidates with Pulmonary Hypertension

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; pp. S285 - S286
• Main Authors: Truby, L.K., Agarwal, R., Russell, S.D., Patel, C.B., Rogers, J.G.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.715

Pulmonary hypertension (PH) is common in patients with heart failure and portends a poor prognosis in heart transplant (HT) recipients. The clinical relevance of discordant PH indices remains unclear. We assessed the post-HT outcomes of patients with elevated pulmonary vascular resistance (PVR) in patients with and without elevated pulmonary artery (PA) pressures. The UNOS database was queried to identify HT recipients with PH (PVR >3) from 1997 - 2017. Patients were then stratified based upon mPA < 36 mmHg and TPG > 15mmHg to assess the additional discrimination of these two variables on post-HT outcomes. In medically managed HT recipients with PH (n=3760)The mean PVR in this patient group was 4.3 ± 1.2 WU with a mean PA pressure of 35.8 ± 9.0 mmHg, a mean PCWP of 21.0 ± 8.1 mmHg, and mean TPG of 14.8 ± 4.8 mmHg. Both mPA pressure < 36 mmHg (HR: 1.21, p=0.079) and TPG > 15 mmHg (HR: 1.28, p=0.025) were associated with worse post-transplant mortality in univariable and multivariable analysis (Figure 1). Secondary analysis was performed in patients BTT with LVAD (n=6664). Compared to medically managed patients with similar PVRs, LVAD patients experienced higher mortality regardless of PVR. Neither mPA pressure nor TPG were associated with 1-year mortality in this population. In medically managed patients with PH, both mPA and TPG refine risk stratification for post-HT mortality. mPA < 36 mmHg, in particular, likely reflects a phenotype of pulmonary vascular disease in combination with RV dysfunction, which portends a worse prognosis after HT. Despite increased 1-year mortality and similar pre-HT hemodynamics, mPA and TPG were unable to further risk stratify patients with PH patients who received a BTT LVAD.