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

Zhenxing Sun; Yu Cai; Yujia Yang; Lei Huang; Yuji Xie; Shuangshuang Zhu; Chun Wu; Wei Sun; Ziming Zhang; Yuman Li; Jing Wang; Lingyun Fang; Yali Yang; Qing Lv; Nianguo Dong; Li Zhang; Haotian Gu; Mingxing Xie

doi:10.1016/j.ijcard.2023.131620

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

Zhenxing Sun, Yu Cai, Yujia Yang, Lei Huang, Yuji Xie, Shuangshuang Zhu, Chun Wu, Wei Sun, Ziming Zhang, Yuman Li, Jing Wang, Lingyun Fang, Yali Yang, Qing Lv, Nianguo Dong, Li Zhang^*, Haotian Gu^*, Mingxing Xie^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: First-phase ejection fraction (EF1) is a novel measure of early changes in left ventricular 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 [26.8–45.0] 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.

Original language	English
Article number	131620
Journal	International Journal of Cardiology
Early online date	29 Nov 2023
DOIs	https://doi.org/10.1016/j.ijcard.2023.131620
Publication status	E-pub ahead of print - 29 Nov 2023

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Sun, Z., Cai, Y., Yang, Y., Huang, L., Xie, Y., Zhu, S., Wu, C., Sun, W., Zhang, Z., Li, Y., Wang, J., Fang, L., Yang, Y., Lv, Q., Dong, N., Zhang, L., Gu, H., & Xie, M. (2023). Early left ventricular systolic function is a more sensitive predictor of adverse events after heart transplant. International Journal of Cardiology, Article 131620. Advance online publication. https://doi.org/10.1016/j.ijcard.2023.131620

@article{03dfbc4d0539460eb0d1a6637ca45164,

title = "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 changes in left ventricular 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 [26.8–45.0] 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.",

author = "Zhenxing Sun and Yu Cai and Yujia Yang and Lei Huang and Yuji Xie and Shuangshuang Zhu and Chun Wu and Wei Sun and Ziming Zhang and Yuman Li and Jing Wang and Lingyun Fang and Yali Yang and Qing Lv and Nianguo Dong and Li Zhang and Haotian Gu and Mingxing Xie",

note = "Funding Information: We acknowledge the financial support from the National Natural Science Foundation of China (grant 81922033 to LZ; 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. Funding Information: Zhenxing Sun, Li Zhang, and Mingxing Xie received research funding from the National Natural Science Foundation of China; Haotian Gu received research funding from the National Institute for Health Research, UK and British Heart Foundation, UK. All authors have no conflicts of interest to declare. Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = nov,

day = "29",

doi = "10.1016/j.ijcard.2023.131620",

language = "English",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Early left ventricular systolic function is a more sensitive predictor of adverse events after heart transplant

AU - Sun, Zhenxing

AU - Cai, Yu

AU - Yang, Yujia

AU - Huang, Lei

AU - Xie, Yuji

AU - Zhu, Shuangshuang

AU - Wu, Chun

AU - Sun, Wei

AU - Zhang, Ziming

AU - Li, Yuman

AU - Wang, Jing

AU - Fang, Lingyun

AU - Yang, Yali

AU - Lv, Qing

AU - Dong, Nianguo

AU - Zhang, Li

AU - Gu, Haotian

AU - Xie, Mingxing

N1 - Funding Information: We acknowledge the financial support from the National Natural Science Foundation of China (grant 81922033 to LZ; 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. Funding Information: Zhenxing Sun, Li Zhang, and Mingxing Xie received research funding from the National Natural Science Foundation of China; Haotian Gu received research funding from the National Institute for Health Research, UK and British Heart Foundation, UK. All authors have no conflicts of interest to declare. Publisher Copyright: © 2023 Elsevier B.V.

PY - 2023/11/29

Y1 - 2023/11/29

N2 - Background: First-phase ejection fraction (EF1) is a novel measure of early changes in left ventricular 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 [26.8–45.0] 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.

AB - Background: First-phase ejection fraction (EF1) is a novel measure of early changes in left ventricular 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 [26.8–45.0] 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.

UR - http://www.scopus.com/inward/record.url?scp=85181705566&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2023.131620

DO - 10.1016/j.ijcard.2023.131620

M3 - Article

SN - 0167-5273

JO - International Journal of Cardiology

JF - International Journal of Cardiology

M1 - 131620

ER -

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

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