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The literature suggests that elevated left ventricular filling pressure (EFP) is associated with longitudinal systolic dysfunction despite the normal ejection fraction (EF) in certain cases. Our aim was to assess the association between EFP and longitudinal systolic function in patients after heart transplantation (HTX) with normal EF (>50%). Patients: 71 consecutive HTX patients (43 males, 28 females; mean age: 50.7±9.5 yrs; median time since HTX: 23 months [range: 1.5-219 months]) were enrolled. Exclusion criteria: grade 2 or above rejection.Methods: EF, wall thicknesses (IVST, PWT), E and A velocities, and deceleration time (DT) of the mitral inflow pattern were measured. Longitudinal systolic (Sa) and diastolic (Ea, Aa) myocardial velocities were measured by tissue Doppler echocardiography at the lateral mitral anulus. The E/A, E/Ea ratios and relative wall thickness (RWT=(IVST+PWT)/Dd, where Dd is the left ventricular end-diastolic dimension) were calculated. EFP was defined as E/Ea≥8.Results: EFP was found in 16 patients (11 males; age: 49.3±12.9 yrs); 51 patients had no EFP (32 males;age: 52.2±8.5 years). There was no difference between the two groups in age, EF, DT and Aa. E velocity, E/A and E/Ea were significantly higher in patients with EFP (E: 100.7±24.9 cm/s vs 76.5±18.6cm/s, p<0.0001; E/A: 2.5±0.8 vs1.8±0.5, p<0.0001; E/Ea: 10.3±2.1 vs5.5±1.2, p<0.0001). In contrast, Ea and Sa velocities, Ea/Aa ratio were singificantly lower in patients with EFP (Ea: 9.8±1.8 cm/s vs 14.2±3.0 cm/s, p<0.0001; Sa: 7.0±2.1 cm/s vs 9.4±2.0cm/s, p=0.001; Ea/Aa: 1.8±0.7 vs2.5±0.9). Sa velocity had a positive correlation with Ea (r=0.64; p<0.0001) and Aa (r=0.27; p=0.03), and a negative correlation with RWT (r= -0.27, p=0.03) and E/Ea (r= -0.49, p<0.0001).Conclusions: elevated left ventricular filling pressure is associated with longitudinal systolic dysfunction in HTX patients with normal ejection fraction and without rejection.