Invasive aortic pulse pressure is linked to cardiac allograft vasculopathy after heart transplantation

Hyun Woong Park, Ilke Ozcan, Takumi Toya, Ali Ahmad, Yoshihisa Kanaji, Sudhir S. Kushwaha, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticlepeer-review


Background: Pulse pressure (PP) has been linked to an increased risk of extent of coronary atherosclerosis and cardiovascular events. This study aimed to investigate the contribution of aortic PP on cardiac allograft vasculopathy (CAV) progression, and cardiovascular events after heart transplantation (HTx). Methods: A total of 330 HTx patients (mean age 49 ± 25 years, 70.0% male) undergoing routine serial coronary intravascular ultrasound (IVUS) studies and had invasive aortic PP were enrolled. The median time from HTx to first IVUS was 13.6 months. CAV progression was assessed by IVUS as the changes (Δ) in plaque volume divided by the segment length (PV/SL), adjusted for the time between IVUS (median, 3.99 years; interquartile range, 1.99–7.20 years), and was defined as ΔPV/SL ≥0.50 mm3/mm/year. Major adverse cardiovascular event (MACE) was defined as any incidence of mortality, myocardial infarction, coronary revascularization, heart failure hospitalization, or re-transplantation. Results: Recipient age, recipient sex, and renal dysfunction were independent determinant of high aortic PP (≥ 50 mmHg). High aortic PP was an independent determinant of CAV progression [odds ratio, 1.72; 95% confidence interval (CI), 1.01–2.93; p = 0.045]. Both high aortic PP (HR 1.46, 95% CI 1.01–2.11, p = 0.044) and high baseline CAV grade on angiogram (≥1, HR 1.50, 95% CI 1.03–2.21, p = 0.037) were independently associated with MACEs over 12 years. Conclusion: In post-HTx patients, high aortic PP was significantly associated with plaque progression. Both aortic PP and CAV grade are independently associated with MACE during long-term follow-up. These findings suggest that arterial stiffness and CAV can be important predictors of MACEs.

Original languageEnglish (US)
Pages (from-to)167-174
Number of pages8
JournalInternational Journal of Cardiology
StatePublished - Jan 1 2023


  • Aortic pulse pressure
  • Cardiac allograft vasculopathy
  • Major adverse cardiovascular events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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