Pulmonary vascular remodeling and prognosis in patients evaluated for heart transplantation. Insights from the OCTOPUS-CHF study

Abstract

Objective: In patients with advanced heart failure, intravascular optical coherence tomography (OCT) of subsegmentary pulmonary arteries measurements are correlated with right heart cath-eterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and echocardiographic estimation of pulmonary pressures in patients se-lected to elective heart transplant. Methods: Observational, prospective, multicenter study in 90 adults with one-year follow-up. Results: A total of 10 patients (11.1 %) died due to worsening heart failure before heart transplantation, 50 underwent heart transplant (55.6%) and 9 died in the first year after transplant. Patients with and without events (mortality or heart failure hospitalization) had similar data from echocardiography, right heart catheterization, and pulmonary OCT (median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range [IQR] 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5; P=0.79, median pulmonary vascular resistance 2.0 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2; P=0.99, median pulmonary artery wall thickness 0.2±0.5 mm vs. 0.2±0.6 mm; P=0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocar-diography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplant. Pulmonary OCT is safe and feasible in the evaluation of these patients.