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Cardiac allograft vasculopathy (CAV) remains the leading long-term cause of death and re-transplantation in heart transplant (HT) recipients. An estimated 30% of HT recipients develop CAV at 5-10 years after transplant. Several immunologic and non-immunologic risk factors are thought to contribute to the development of CAV, however the impact of modifiable traditional cardiovascular risk factors such as hypertension on the risk of CAV has not been well described. In this single center retrospective analysis, we sought to evaluate the relationship between blood pressure control and prevalence of CAV at 5 years post-transplant. : Hypertension is associated with increased risk of CAV at 5 years post-HT. We retrospectively identified adults (>18 years) who had undergone HT at our institution between 2011-2020. In-office blood pressure readings were recorded from visits timed 2 months, 1, 3, 5, and 10 years post-HT and averaged until first CAV event or until duration of follow up in those without CAV. Coronary angiograms performed for CAV surveillance at 2 months, 1, 3, 5, and 10 years were reviewed by two cardiologists and CAV was graded per the International Society of Heart and Lung Transplant classification. Subjects were categorized as high systolic blood pressure (SBP) (defined as average SBP >130) or controlled (≤130) and compared for development of CAV. Of a total of 313 HT recipients, those with missing data or who did not make it to their first angiogram were excluded; the remaining 260 were included in the study. The mean age at HT was 54 ± 14 years and 83 HT recipients (32%) were female. In total, 77 recipients (30%) had CAV over a median follow-up time of 3.1 years. Of the ninety-six recipients who completed 5 year follow up, 23 (24%) had evidence of CAV on 5-year surveillance angiogram. Nearly two thirds (66%) of the patients received antihypertensives. On time to event analysis for the overall cohort (Figure 1), patients with an average systolic blood pressure of over 130 mmHg were at higher risk for CAV compared to those with an average systolic BP of ≤130 mmHg (unadjusted HR 2.4, 95% CI 1.122-5.176, p =0.02). Hypertension is associated with the development of CAV post-HT. Further therapeutic studies on whether appropriate BP control can mitigate risk of CAV are required. [ABSTRACT FROM AUTHOR]

Jugular venous pressure (JVP) is a widely used estimate of central venous pressure (CVP). It is unclear how accurate JVP measurement is by physicians in different stages of clinical practice. We investigated the accuracy of JVP measurement across different levels of medical training by comparing JVP measurements to the peripheral venous pressure (PVP) measurement, which has been shown to have a high degree of correlation to CVP measurements. JVP will be better correlated with CVP when measured by physicians of higher level of clinical training. A prospective, cross-sectional study in which 82 participants (13 third or fourth-year medical students, 26 interns, 21 residents, and 22 attending internal medicine physicians) measured JVP in patients admitted for acute decompensated heart failure (ADHF) to the general medicine ward. JVP measurements were compared to the PVP measured from a peripheral intravenous catheter by standard technique. Forty-five patients were enrolled with a mean age of 69±14 years, mean body mass index (BMI) of 31±9 kg/m2, mean ejection fraction (EF) of 47±20%, and mean B-type natriuretic peptide (BNP) of 1242±1161 pg/ml. Mean JVP was 8.6 (4-18) cmH 2 O for medical students, 8.7 (4-16) cmH 2 O for interns, 9.1 (5-20) cmH 2 O for residents, and 9.2 (4-15) cmH 2 O for attending physicians. Mean PVP was 8.7 (1-20) mmHg. The JVP and CVP were found to have a moderate correlation (r=0.42, p=0.005) for attending physicians and a low correlation for medical students or residents. High-degree correlation among attending physicians was noted in patients with EF < 50% (r=0.60, p=0.009), BMI < 30 (r=0.55, p=0.008) and BNP > 1000 (r=0.56, p=0.01). JVP is a reliable estimation of volume status in those admitted with ADHF when examined by an attending-level internal medicine physician, specifically in patients with a low BMI, low EF, and a high BNP. [ABSTRACT FROM AUTHOR]