P317Prognostic role of myocardial performance index after heart transplantation: a prospective study


    loading  Checking for direct PDF access through Ovid

Abstract

Background: Myocardial performance index (MPI) is a Doppler-derived index of combined systolic and diastolic function. Abnormal MPI is a reliable marker of early graft dysfunction because of chronic rejection. We evaluated the prognostic role of MPI in a prospective cohort of long term (> 1 year) heart transplanted (HT) patients (pts).Methods: In this prospective study 152 long term (time from transplant: 5.2 ± 3.6 years) HT pts (54.6 ± 12.2 years) were enrolled. Protocol includes echocardiografic (887 exams) and clinical annual follow up. Prespecified cut-off values of increased risk of events were: FE ≤ 50% and MPI ≥ 0.45. The primary end point was a composite of death from cardiovascular causes, hospitalization for cardiac disease and heart failure; secondary end point was cardiac death.Results: During follow-up (69 ± 22 months) 68 patients (44.7%) had any event (1.6 ± 0.9 event/patient). Overall cardiac mortality rate was 13.16%. Among all the prespecified clinical (recipient age, time from transplantation, diabetes mellitus, number and degree of rejection during the first year, immunosuppressive and heart failure treatment) variables, use of tacrolimus and mycophenolate significantly correlated with a reduced risk of events (respectively: odds ratio 0.35; 95% CI: 0.12-0.92; p 0.03; odds ratio 0.42; 95% CI: 0.19-0.85; p 0.02) whereas diabetes was a risk factor for events (OR: 2.26; 95% CI: 1.03-5.1; p: 0.04). Patients who had events during follow-up showed at echo-Doppler examination lower EF (56.2 ± 10.6 vs. 62.9 ± 6.7 p <0.001) and higher MPI (0.42 ± 0.18 vs. 0.36 ± 0.13; p 0.017). EF and MPI were not correlated (r2 0.2). Both parameters showed a good diagnostic power for events (EF: ROC area 77%, with sensitivity 54% and specificity 91% for cut-off value of 50%; MPI: ROC area 79%, with sensitivity 79% and specificity 81% for cut-off value of 0.45). At Kaplan Meier analysis, EF ≤ 50% and MPI ≥ 0.45 were associated with decreased freedom from first cardiac event (10 years: 24% vs. 73%, p < 0.0001; 41% vs. 75%, p < 0.00001; respectively). MPI and EF significantly predicted cardiac events (MPI ≥ 0.45: OR 16.08, 95% CI 9.746-27.37; EF ≤ 50%: OR 13.64, 95% CI 8.55-21-92) and death (MPI ≥ 0.45: OR 27.7, 95% CI 7.35-178, p < 0.001; EF ≤ 50% : OR 8.6, 95% CI 3.45-22.11, p < 0.001). Only 2% of patients with EF > 50% and MPI < 0.45 had events during follow-up.Conclusions: MPI is a new prognostic index for long-term event free survival after HT. Combining MPI with EF can enhance the prognostic power of the echocardiographic examination.

    loading  Loading Related Articles