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Purpose: Heart transplantation (HTx) improves survival in patients with congestive heart failure. Guidelines recommend pre-transplant graft ischemic time (GIT) less than 4 hours, but in the need for suitable donors, grafts with ischemic time above 4 hours are accepted. The impact of GIT on cardiac function has not been investigated with newer, sensitive echocardiographic techniques. Thus, we studied whether GIT influence exercise capacity and post-transplant systolic and diastolic function by tissue Doppler (TDI).Methods: 52 HTx recipients without rejection or clinical heart failure underwent echocardiography with colour-TDI and a maximal symptom-limited treadmill exercise capacity test 1-8 years (median 4 years) after HTx. Left ventricular (LV) systolic (s') and early diastolic (e') mitral annular velocities, right ventricular (RV) s', RVe' as well as LV ejection fraction (EF) were analyzed.Results: GIT ranged from 41- 301 minutes. HTx recipients with GIT ≥ median value (200 min) had significantly lower LVs' septal, LVe' septal, RVs' and RVe' velocities than recipients with GIT < median (table). HTx recipients with GIT ≥ 200 min also had significantly lower EF and a trend towards a lower VO2peak. There were no significant differences in recipient age, donor age, etiology of heart failure, BMI, or time since HTx between the groups.Conclusions: Prolonged GIT is associated with reduced systolic and diastolic annular velocities in the interventricular septum and the RV, and a lower LV EF. Although the impairment is moderate, GIT should be taken into account when assessing cardiac dysfunction after HTx. The long term consequenses of this impairment for graft dysfunction and long term survival should be investigated.