Heart transplantation and arterial elasticity

Abstract

Objective:

Arterial elasticity is a functional biomarker that has predictive value for cardiovascular morbidity and mortality in nontransplant populations. There is little information regarding arterial elasticity in heart transplant recipients. This study aimed to characterize small (SAE) and large (LAE) artery elasticity in heart transplant recipients in comparison with an asymptomatic population free of overt cardiovascular disease. A second goal was to identify demographic and clinical factors associated with arterial elasticity in this unique population.

Methods:

Arterial pulse waveform was registered noninvasively at the radial artery in 71 heart transplant recipients between 2008 and 2010. SAEs and LAEs were derived from diastolic pulse contour analysis. Comparisons were made to a healthy cohort of 1,808 participants selected from our prevention clinic database. Multiple regression analyses were performed to evaluate associations between risk factors and SAE and LAE within the heart transplant recipients.

Results:

LAE and SAE were significantly lower in heart transplant recipients than in the normal cohort (P < 0.01 and P < 0.0001, respectively). Female sex and history of ischemic cardiomyopathy were significantly associated with reduced LAE and SAE. Older age and the presence of moderate cardiac allograft vasculopathy were also significantly associated with reduced SAE. Transplant duration was associated with increased SAE.

Conclusion:

Heart transplants are associated with peripheral endothelial dysfunction and arterial stiffness, as demonstrated by a significant reduction in SAE and LAE when compared with a healthy population. Furthermore, cardiac allograft vasculopathy is associated with a significant reduction in SAE, suggesting a potential use in screening heart transplant recipients at risk for developing this complication.

Keywords::

• heart transplant
• endothelial function
• arterial elasticity
• cardiac allograft vasculopathy

Acknowledgments

Special thanks to Jay Cohn, MD, who provided guidance regarding study design and interpretation of results, to Greg Grandits, PhD, for preliminary analyses, to Eduardo Medina who helped initiate this study, and to Anne Marie Weber-Main, PhD, who critically reviewed and edited article drafts.

Disclosure

Dr Colvin-Adams receives grant support through the National Institutes of Health K12 program and the American Heart Association. This research was partially funded by the National Institutes of Health. The authors report no other conflicts of interest in this work.