The Impact of Left Atrial Strain on Mortality and Retransplantation in Heart Transplant Recipients = 좌심방 변형률이 성인 심장이식 환자의 사망과 재이식에 미치는 영향

다국어 초록 (Multilingual Abstract)

Background:
Left atrial (LA) strain has emerged as a non-invasive marker of left ventricular (LV) filling pressure and diastolic function. While LA strain has shown prognostic value in various cardiovascular populations, its clinical utility in adult heart transplant recipients remains inadequately explained. This study investigated prognostic implication of LA strain in adult heart transplant recipients.

Methods:
An observational cohort study was conducted among adult heart transplant recipients who underwent coronary angiography with concomitant left ventricular end-diastolic pressure (LVEDP) measurement and echocardiography within 4 months between Jan 2018 and Dec2021. The primary endpoint was graft survival defined by a composite of all-cause mortality or retransplantation. Low LA reservoir strain (LARS) group was defined as LARS ≤11.2%

Results:
A total of 133 patients were analyzed (16 [12.0%] with low LARS ≤11.2%). During a median follow-up of 1,580 days, a total of 15 patients (11.3%) experienced the primary outcome.
LVEDP was inversely correlated with LARS (r = −0.269, p = 0.002). Low LARS was associated with increased risk of the study outcome in multivariable regression analysis(hazard ratio 5.77, 95% confidence interval 1.50–22.22, p = 0.011).
After propensity score matching to balance baseline characteristics (32 high- vs. 16 low-LARS patients), graft survival remained significantly lower in the low-LARS group (p = 0.014).

Conclusions:
Reduced LARS was correlated with elevated LVEDP. LARS can predict outcomes after adult heart transplantation. LA strain may serve as a non-invasive marker for post-transplant surveillance and risk stratification.

목차 (Table of Contents)

• Summary i
• Table of Contents iii
• List of Tables iv
• List of Figures v
• Introduction 1
• Methods 3
• Results 7
• Discussion 19
• Conclusion 22
• References 23
• Supplementary Tables 26
• Supplementary Figures 27
• Korean Summary 29