Background: Aortic augmentation index (AI_a), a measure of arterial pressure wave reflection related to central and/or peripheral arterial stiffness, is elevated in many heart transplant recipients (HTRs). C-reactive protein (CRP), a marker of systemic inflammation associated with ischemic heart disease, is an independent predictor of cardiac allograft vasculopathy and death in HTRs. We hypothesized that arterial wave reflection would be higher in HTRs with ischemic compared with non-ischemic heart failure etiology and this would be associated with circulating CRP early after transplantation.

Methods: Two months after heart transplantation, 20 HTRs underwent non-invasive measurement of aortic pressure and wave reflection properties adjusted for heart rate (Sphygmocor, AtCor Medical) and plasma metabolic and inflammatory markers.

Results: Aortic AI_a was higher in HTRs with ischemic (n=12) compared with non-ischemic (n=8) heart failure (mean±SD; 22.5 ± 11.0 vs. 11.6 ± 10.5%, p<0.01). Similarly, circulating CRP was higher in HTRs with ischemic compared with non-ischemic heart failure (5.4 ± 4.5 vs. 1.4 ± 1.1 mg/L, log transformed p<0.05). Moreover, there was a significant relation between logCRP and AI_a (r=0.68, p<0.05), roundtrip time of the reflected wave to the peripheral reflecting sites and back (r=−0.62, p<0.01), and left ventricular wasted energy (r=0.55, p<0.01). When adjusted for CRP, the difference in AI_a between groups was abolished suggesting that circulating CRP contributed in part to the group differences in wave reflection.

Conclusions: HTRs with ischemic heart failure etiology demonstrated increased arterial wave reflection compared with HTRs with non-ischemic heart failure early after transplantation and this was associated with higher circulating CRP.