Prognostic Value of Cardiac CT-Derived RV Dysfunction in Lung Transplantation Candidates: A Single-Center Retrospective Study.

Abstract

Background: There are no specific criteria for listing and prioritizing lung transplantation (LTx) candidates based on the severity of right ventricular (RV) dysfunction. We evaluated the prognostic value of cardiac CT-derived RV ejection fraction (RVEF) in LTx candidates.

Methods: This retrospective study included patients who were listed for LTx and underwent cardiac computed tomography (CT) between September 2019 and December 2023. Patients were categorized into three groups based on CT-derived RVEF and survival analyses were performed among these groups: normal RVEF (≥ 45%), mild-to-moderate RV dysfunction (25%-45%), and severe RV dysfunction (< 25%).

Results: In the 203 patients (median age, 61 years [interquartile range [IQR], 54-64]), the most common indication for LTx was interstitial lung disease (79.3%). Patients were followed for a median duration of 297 days (IQR, 140-632), and the one-year survival rates were 85.2% for those with normal RV, 69.3% for those with mild-to-moderate RV dysfunction, and 55.6% for those with severe RV dysfunction (p < 0.001). Severe RV dysfunction (hazard ratio [HR] 6.72, p = 0.020), age (HR 1.1, p = 0.010), and 6-minute walking distance (HR 0.62, p = 0.010) were associated with an increased risk of one-year mortality.

Conclusions: Severe RV dysfunction identified on cardiac CT was a significant prognostic factor for one-year mortality in LTx candidates. Patients with severe RV dysfunction should be prioritized for LTx and classified as urgent due to their elevated short-term mortality risk. Cardiac CT may provide valuable prognostic information during the pre-transplant evaluation process.