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Background: Preoperative amiodarone effects on postorthotopic heart transplant (OHT) outcomes remain controversial., Objective: The purpose of this study was to determine the effect of cumulative pre-OHT amiodarone exposure on severe primary graft dysfunction (PGD)., Methods: We retrospectively reviewed adult OHT recipients between August 2012 and June 2018. Primary outcome was severe PGD in patients receiving amiodarone at 3, 6, and 12 months prior to OHT compared with those not receiving amiodarone. Secondary outcomes included intensive care unit (ICU) and hospital length of stay, duration of mechanical ventilation, early graft failure (EGF), mortality at 3, 6, and 12 months post-OHT, and 30-day incidence of postoperative tachyarrhythmias, bradycardia, permanent pacemaker implantation, and rejection., Results: Incidence of severe PGD was 12.5% in those who received amiodarone compared to 6.8% in those who did not (14 vs 6, P = 0.18). Cumulative preoperative amiodarone significantly increased the odds of severe PGD at 3 months (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.001-1.06; P = 0.044) and 6 months (OR: 1.02, 95% CI: 1.003-1.044; P = 0.024) in a multivariate logistic regression. Patients on amiodarone had significantly higher rates of postoperative bradycardia (13.4% vs 4.5%, P = 0.03)., Conclusion and Relevance: A trend toward increased PGD was present in patients receiving preoperative amiodarone. This finding combined with the regression showing significantly increased odds of PGD with increasing 3 and 6 month cumulative amiodarone dose is clinically concerning. Escalation of care with pacemaker implantation was required more frequently in patients on pre-OHT amiodarone., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Exercise performance remains limited in some patients after heart transplantation (HTx). The goal of this study was to assess for association between cardiopulmonary exercise test performance at 1 year after HTx and future development of cardiac allograft vasculopathy (CAV)., Methods: Overall 243 HTx recipients performed cardiopulmonary exercise testing at 1 year after HTx. During the median follow-up period of 31 (interquartile range 19;61) months, 76 (32%) patients were diagnosed with CAV (CAV group)., Results: The CAV group patients had lower exercise capacity (5.2 ± 1.9 versus 6.5 ± 2.2 metabolic equivalents; P = 0.001) and duration (9.6 ± 3.5 versus 11.4 ± 4.8 min; P = 0.008), lower peak oxygen consumption (VO2) (18.4 ± 5.4 versus 21.4 ± 6.1 mL/kg/min; P = 0.0005), lower normalized peak VO2 (63% ± 18% versus 71% ± 19%; P = 0.007), and higher minute ventilation (VE)/carbon dioxide production (VCO2) (34 ± 5 versus 32 ± 5, P = 0.04). On Cox proportional hazards regression analysis, normalized peak VO2 ≤60%, and VE/VCO2 ≥34 were associated with a high hazard for CAV (HR = 1.8 [95% CI 1.10-4.53, P = 0.03] and 2.5 [95% CI 1.01-8.81, P = 0.04], respectively). The subgroup of patients with both normalized peak VO2 ≤60% and VE/VCO2 ≥34 was at highest risk for development of CAV (HR = 5.2, 95% CI 2.27-15.17, P = 0.001)., Conclusions: Normalized peak VO2 ≤60% and VE/VCO2 ≥34 at 1 year after HTx are associated with the development of CAV.

Clinical Features: Giant cell myocarditis (GCM) is a rare and a rapidly progressive disorder with fatal outcomes such that patients often require heart transplantation. We present a case of recurrent GCM in a transplanted patient with a history of Crohn disease requiring a novel therapeutic approach., Therapeutic Challenge: After the orthotopic heart transplantation, GCM recurred on aggressive immunosuppression over the months, which included corticosteroids, basiliximab, tacrolimus, antithymocyte globulin, and rituximab. Although combination immunosuppressive therapy containing cyclosporine and 2-4 additional drugs including corticosteroids, azathioprine, mycophenolate mofetil, muromonab, gammaglobulin, or methotrexate have shown to prolong the transplant-free survival by keeping the disease under control, its role in preventing and treating recurrence posttransplantation is unclear., Solution: We added sirolimus, a macrolide antibiotic, with properties of T- and B-lymphocyte proliferation inhibition on the above immunosuppressive treatment postrecurrence of GCM. After sirolimus initiation and continuation, the patient has remained disease free.

Background: The effect of elevated heart rate (HR) on outcomes after heart transplantation (HT) has not been well established. The aim of this study was to assess predictors of elevated HR following HT and its impact on outcomes., Methods and Results: We retrospectively evaluated 394 patients who underwent HT at 2 academic medical centers from 2005 to 2016. Patients were divided into 2 groups based on HR 1 year after HT: HR ≥95 beats/min (n = 162; 41%) and HR <95 beats/min (n = 232; 59%). Median follow-up time was 6.6 (interquartile range [IQR] 2.2-7.5) years. HR ≥95 beats/min 1 year after HT was associated with younger donor age, whereas HR <95 beats/min was associated with heavy donor alcohol use and African-American recipient race. Left ventricular (LV) end-diastolic dimension, mass, and ejection fraction were lower and E/E' higher in the HR ≥95 group at the time of the last follow up. HR ≥95 beats/min at 1 year after HT was independently associated with the development of cardiac allograft vasculopathy and increased mortality., Conclusions: HR ≥95 beats/min 1 year after HT is associated with a reduction in LV size and function, increased incidence of cardiac allograft vasculopathy, and reduced survival. Studies investigating the effect of medical HR reduction on post-HT outcomes are warranted., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Current guidelines recommend against the use of hearts from donors that abuse alcohol. We explored the effect of donor alcohol abuse (AA) on cardiac allograft function and outcomes in heart transplant (HTx) recipients., Methods: Overall, 370 HTx recipients were divided into two groups: (a) the alcoholic donor group (AD, n = 58) and (b) the non-alcoholic donor group (NAD, n = 312)., Results: Recipients in the AD group had a slower heart rate (86 ± 13 vs 93 ± 13, P = 0.004) and an increased incidence of early atrial fibrillation (AF) (30% vs 11%, P = 0.003). Echocardiographic left ventricular mass was higher among alcoholic donors (171.7 ± 66.7 vs 151.6 ± 54.7, P = 0.02). This difference remained present 1 year following HTx (185 ± 43 vs 166 ± 42, P = 0.007). E/E' was higher in the AD group (9.5 ± 3.9 vs 8.4 ± 2.9, P = 0.04) and a larger number of AD recipients had a ventilatory equivalent for VCO 2  > 34 (50% vs 31%, P = 0.04) on cardiopulmonary exercise test. There was no significant difference in rejection, cardiac allograft vasculopathy (CAV), or survival between the groups., Conclusions: Our data suggest that donor AA does not impact rejection, CAV, or intermediate-term survival, but may cause increased incidence of post-HTx AF and impaired cardiac allograft diastolic function., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Sinus tachycardia (ST) is common after heart transplantation (HTx). The aim of the study was to evaluate the effect of diltiazem treatment during the first year after HTx on heart rate (HR), cardiac allograft function, and exercise capacity., Methods: From the total cohort, 25 HTx recipients started diltiazem treatment 4±2 weeks after HTx and continued it for at least 1 year (diltiazem group). Each study case was matched to a control. All patients underwent hemodynamic assessment and cardiopulmonary exercise test (CPET) at 1 year after HTx., Results: HR decreased in the diltiazem group from 99±11 bpm to 94±7 bpm (P=.03) and did not change in the controls (98±11 bpm vs 100±13 bpm, P=.14). The difference between the groups at 1 year after HTx was significant (P=.04). In the diltiazem group left ventricular (LV), stroke volume and ejection fraction increased (48±16 vs 55±17 mL, P=.02, and 60%±10% vs 62%±12% P=.03, respectively) but did not differ from controls. E/E' decreased (10.7±2.7 vs 7.3±1.9, P=.003) while cardiac index was higher (3.5±0.8 vs 3.1±0.5; P=.05) in the diltiazem group at 1-year follow-up. The absolute peak VO 2 (21±4 vs 18±6 mL/kg/min; P=.05) and normalized peak VO 2 (73%±17% vs 58%±14%; P=.004) were significantly higher in the diltiazem group., Conclusions: This study showed that diltiazem treatment reduces ST, may improve cardiac allograft function and exercise tolerance during the first year after HTx., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Sinus tachycardia often presents in heart transplantation (HTx) recipients, but data on its effect on exercise performance are limited., Methods: Based on mean heart rate (HR) value 3 months after HTx, 181 patients transplanted from 2006 to 2015 at University of Nebraska Medical Center were divided into two groups: (i) HR<95 beats/min (bpm, n=93); and (ii) HR≥95 bpm (n=88). Cardiopulmonary exercise testing (CPET) was performed 1 year after HTx., Results: Mean HR at 3 months post-HTx was 94±11 bpm and did not change significantly at 1 year post-HTx (96±11 bpm, P=.13). HR≥95 bpm at 3 months was associated with younger donor age (OR 1.1; CI 1.0-1.1, P=.02), female donors (OR -2.4; CI 1.16-5.24 P=.02), and lack of donors' heavy alcohol use (OR -0.43; CI 0.17-0.61; P=.04). HR≥95 bpm at 3 months post-HTx was independently associated with decreased exercise capacity in metabolic equivalent (P=.008), reduced peak VO 2 (P=.006), and percent of predicted peak VO 2 (P=.002) during CPET., Conclusions: HR≥95 at 3 months following HTx is associated with reduced exercise tolerance in stable HTx recipients. Medical HR reduction after HTx could improve exercise performance after HTx and merits further investigation., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Cardiac transplantation in many centers is programmatically limited to patients aged younger than 70 years. We investigated the trends and outcomes for cardiac transplantation in recipients aged 70 years and older in the United States., Methods: De-identified data were provided by United Network of Organ Sharing. Transplant recipients were grouped by age 60-69 years and 70 years and older. Univariate comparisons were performed using Student's t-test or the Pearson chi-square test. Survival was estimated using the Kaplan-Meier technique and compared with the log-rank test. Cox regression was used to determine predictors of death after transplant. Statistical significance was assigned to p < 0.05., Results: Between January 1, 1998, and June 15, 2010, 5,807 sexagenarians and 332 septuagenarians received allografts. The septuagenarian cohort had more men, less diabetes, was less likely to have a ventricular assist device, and more likely to be status II. Donors for septuagenarians were older and died more frequently from intracranial hemorrhage. Median unadjusted survival was 9.8 years for sexagenarians vs 8.5 years for septuagenarians (p = 0.003). There was no difference in the incidence of cerebrovascular accident, length of stay, or pacemaker need between groups. Septuagenarians were less likely to be treated for rejection the first year (p = 0.001). Age was a multivariate predictor of death (hazard ratio, 1.289; 95% confidence interval, 1.039-1.6; p = 0.021)., Conclusions: Selected septuagenarians with advanced heart failure can derive great benefit from cardiac transplantation, although survival is inferior to that of an immediately younger sexagenarian cohort. Most of the mortality risk is seen in the first year after transplantation. A reduced incidence of rejection was observed and warrants further study., (Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

While bronchiolitis obliterans organizing pneumonia (BOOP) has been associated with the use of sirolimus (SIR), the incidence in a consecutive group of patients given SIR to replace a calcineurin-inhibitor (CI) is unknown. Twenty-nine consecutive cardiac transplant recipients were switched from a CI to SIR to ameliorate CI-associated nephropathy or coronary graft atherosclerosis. Seven patients (24%) developed BOOP. The clinical characteristics and biopsy results of these patients are presented. The clinical course and response to withdrawal of SIR in all and steroids in four of seven patients suggested the diagnosis of BOOP. Chest X-rays and CT scans showed typical findings of BOOP in all seven patients. Infection was excluded in all patients. Biopsy results were characteristic of BOOP in six of seven patients. Six patients recovered and one died. BOOP is a common and potentially serious adverse event in cardiac transplant patients switched from a CI to SIR, especially when SIR is started late post-transplantation.

The incidence of mammalian target of rapamycin inhibitor (mTORi) associated bronchiolitis obliterans organizing pneumonia (BOOP) varies in the literature. We have previously reported a 24% incidence of BOOP in patients transitioned to sirolimus. This high rate was believed to be related to the full withdrawal of calcineurin inhibitor (CI) therapy. The aim of this study is to compare those results to our current practice of maintaining a low-dose CI with mTORi-based regimens This was a single-center retrospective review of adult heart transplant recipients initiated on an mTORi at least six months post-transplant. The primary outcome of the study was incidence of BOOP. Secondary outcomes included timing of mTORi conversion post-transplant and associated tacrolimus concentrations. During the study period, none of the 61 included heart transplant patients developed BOOP. Late mTORi transition (>1 year post transplant) was more common (72%) than early conversion (6 months - 1 year post transplant; 28%), and sirolimus was more commonly utilized than everolimus (90% vs 10%). Following our centers mTORi conversion policy, all patients were maintained on low-dose tacrolimus at initiation, with 84% of patients continuing concomitant tacrolimus at one year. Of these patients, 46% had an FK goal < 4 mcg/mL and 38% had an FK goal 4-8 mcg/mL. No patients at our center experienced mTORi related BOOP while maintaining a low dose CI. The results of this study suggest calcineurin inhibitors have a protective effect from BOOP, even at low concentrations. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is common after orthotopic heart transplantation (OHT) due to steroid-induced hyperglycemia. Traditionally, it has been treated using parenteral insulin therapy. The use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in OHT recipients is not well established. A retrospective chart review was performed on all the patients who underwent OHT at our center to identify patients on SGT2i post OHT. Clinical outcomes pre and post SGLT2i therapy were compared using the student t-test. Out of the 455 patients who had OHT at our single institution, 26 patients were on SGLT2i post OHT (1 patient was dual organ recipient - heart and liver transplant). The baseline characteristics are reported in Table 1. The median days from OHT to initiation of SGLT2i was 780 days (range 40-4986 days), and the median duration of therapy post-OHT was 169 days (range 38-2474 days). There was a statistically significant improvement in the average hemoglobin A1c, weight, and body mass index after starting SGLT2i (Results table). There was a trend towards improving renal function. There was no incidence of systemic infection, hypoglycemia, amputation, or euglycemic diabetic ketoacidosis while on SGLT2i. Two patients were able to discontinue insulin therapy after starting SGLT2i. There was no incidence or progression of cardiac allograft vasculopathy during the therapy. Two patients experienced graft rejection (1Antibody Mediated Rejection and 1 Acute Cellular Rejection) with drop in left ventricular systolic function that recovered after appropriate treatment. SGLT2i can be used safely in OHT recipients. The renal protective mechanism of SGLT2i could be helpful to combat the nephrotoxicity of calcineurin inhibitors (CNI) used for immunosuppression and help prolong the use of CNI. Further randomized studies are required to explore the complete benefits of SGLT2i in OHT recipients [ABSTRACT FROM AUTHOR]

Coronary allograft vasculopathy (CAV) is diffusely accelerated atherosclerosis of the donor heart and continues to limit longterm survival and drive need for re-transplant. To date, only statin therapy has reduced CAV-related mortality. PCKS9 inhibitors are a new lipid lowering therapy shown to reduce cardiovascular clinical events in patients with coronary artery disease. We hypothesized that PCSK9 inhibition via evolocumab will significantly lower LDL and be well-tolerated in transplant patients with CAV. We completed a phase II, open label, single center clinical trial investigating the impact of evolocumab in heart transplant patients with CAV. Heart transplant patients (n=26) ages 19-80 with coronary allograft vasculopathy diagnosed by angiography were enrolled. Exclusion criteria included recent rejection or infection requiring IV therapy (within the past 3 months), acute liver dysfunction, renal dysfunction with GFR less than 20 ml/min, current or recent use of a PCSK9 inhibitor (within the past 3 months), and/or known allergy to evolocumab. Patients were targeted for enrollment at their annual evaluation, and received evolocumab (140 mg every 2 weeks, subcutaneous injection) for one year in addition to standard of care. Repeat lipid profiles were obtained after 3 months of therapy for the primary endpoints. Immunosuppression levels were monitored quarterly. Change in CAV after one year of evolocumab were assessed by quantitative coronary angiography. Adverse events were assessed at weeks 2, 4, 12, 26, 38, and 52 of treatment. Amgen, Inc. provided investigator support and study drug for this trial. The primary endpoint was percentage LDL change from baseline at week 12. Secondary endpoints included assessment of evolocumab on (1) CAV progression as assessed by quantitate coronary angiography, (2) immunosuppression and incidence of rejection, and (3) lipid profile at 1 year. Adverse events were also documented to assess safety of evolocumab in the transplant population. [ABSTRACT FROM AUTHOR]

Cardiac allograft rejection (AR) diagnosis has historically relied on endomyocardial biopsy (EMBx) and histopathology (HP). Quantifying donor-derived cell free DNA (ddcfDNA) has recently offered a non-invasive alternative for detecting graft injury. EMBx mRNA analysis via the molecular microscope profiles (MMP) quantifies AR probability not subject to HP interpretation. Our aim was to evaluate the clinical role of MMP in cardiac transplant recipients (HTx) with positive ddcfDNA. We identified 39 patients with ddcfDNA testing and subsequent EMBx for HP (n=36) and MMP (n=39) analysis. MMP was conducted by the molecular microscope diagnostic system (MMDX™). Patients with multi-organ transplantation or coronary allograft vasculopathy were excluded. MMP, HP, echo and ddcfDNA association were assessed using logistical regression (SPSS™). Average time post-transplant was 1585 ±1435 days, average LVEF 55%, and average ddcfDNA 0.81 ± 1.1. Donor specific antibodies were present in 14/39 of patients. MMP was abnormal in 18/39 patients and correlated with ddcfDNA levels (p=0.007) and HP (p=0.05), but not with LVEF (p=0.71). MMP abnormalities included 9 antibody mediated rejection (AMR), 5 acute cellular rejection (ACR), and 4 injury patterns. By HP, biopsies were abnormal in 18/36 patients: 18 ACR (grade 1) and 1 AMR (grade 2). Abnormal HP did not correlate with ddcfDNA levels (p= 0.07). HP and MMP are often discordant, Table 1. Abnormal MMP correlated with both ddcfDNA and HP, but not with LVEF. Large prospective clinical trials are needed to define clinical outcomes from treatment strategies based on biopsy results. Multi-modality testing may be necessary to monitor cardiac transplant patients for rejection and avoid misclassification. [ABSTRACT FROM AUTHOR]

Renal insufficiency is common in heart transplant recipients and is associated with increased all-cause cardiovascular mortality. The use of mammalian target of rapamycin inhibitor (mTORi)-based immunosuppression may help mitigate the renal insufficiency associated with calcineurin inhibitors (CI), however complete CI withdrawal is associated with an increased risk of rejection. This study aims to evaluate the effect of mTORi-based immunosuppression with low dose tacrolimus on renal function in patients post-cardiac transplant. This was a single-center retrospective study of adult heart transplant recipients who were initiated on an mTORi at least six months post-transplant. The primary outcome of this study was change in renal function from pre-conversion to 3-, 6-, and 12-months post-mTORi initiation. Patients served as their own controls from pre-to-post conversion. A total of 61 heart transplant patients met inclusion criteria. At baseline, all patients remained on concomitant tacrolimus which was continued in 84% of patients at one year. Renal function for all patients was significantly improved at 3 months (p = 0.001) and 6 months (p = 0.004) post conversion, although the largest impact was seen in those with a baseline eGFR < 35mL/min/1.73m2. Change in renal function over time also differed by goal tacrolimus level. For patients with FK level less than 4 ng/mL, there was a significant main effect of time on eGFR (p=0.0004). There were no significant differences in renal function for the goal tacrolimus ranges of 4-6 ng/mL or 6-8 ng/mL at any time point. There were no identified safety concerns and no difference in rejection. Overall, conversion to mTORi-based immunosuppression with low dose CI was shown to be associated with improved renal function at 3- and 6-months post conversion. Renal recovery appeared to be greatest for patients with baseline eGFR <35 mL/min/1.73m2 and in those with an FK goal < 4 ng/mL. To our knowledge, this is one of the first studies to describe the impact of FK goal levels on renal function post-conversion to mTORi-based immunosuppression. These results suggest renal improvement may be feasible while maintaining low target levels of CI therapy. [ABSTRACT FROM AUTHOR]

Purpose While exercise capacity has been shown to improve following heart transplantation, transplant patients still have subnormal exercise capacities. We aimed to determine the natural history of exercise capacity post-transplant and whether resting heart rate impacts exercise capacity Methods Retrospective chart review was performed and patients who underwent multiple cardiopulmonary exercise testing (CPET) post-heart transplantation were identified. Fisher's exact test was used to compare categorical data with CPET variables and the Mann-Whitney test was used to compare continuous measures. Measurements over each year were considered repeated measures and fit with a linear mixed effect model. Results A total of 93 patients underwent CPET at 1-year post-transplant, 44 at 2 years, 32 at 3 years, and 17 at 4 years. The average age was 56.1(± 12.6) years, 87 (93.6%) patients were Caucasian, and 64 (68.2%) patients were male sex. There were no significant changes in CPET variables over the first four years following heart transplantation (Table 1). Resting heart rate at 1 year (≤ 95 vs >95) did not significantly impact exercise capacity after heart transplant. Patients with lower peak VO2 (<70% predicted) at 1-year post-transplant exhibited significant improvement in exercise capacity over time (p=0.004) while those with near normal exercise capacity (>70% predicted) remained stable over time. Conclusion While exercise capacity improves following heart transplantation, continued improvement was not observed in our transplant population. Resting heart rate following heart transplantation does not impact exercise capacity. [ABSTRACT FROM AUTHOR]

Lung disease is common in the advanced heart failure population. While pulmonary function testing (PFT) is typically performed as part of a heart transplant evaluation, little is known regarding the prognostic utility of PFTs for outcomes after transplantation. We evaluated whether PFT parameters correlated with survival, length of stay, or time on ventilator following heart transplantation. International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant (TTX) registry data was combined with single-center data from the University of Nebraska Medical Center. Cox proportional hazard modeling was used to evaluate univariate and multivariate predictors of survival. A total of 1083 patients (802 from a total of 62,327 from the TTX registry, 281 from the UNMC database) had pre-transplant PFT data available for evaluation. At the time of transplant, the mean age was 50.6 (± 14.5) years, 24.2% were female, 51% had a history of tobacco use, and 8% had a history of chronic obstructive pulmonary disease. Forced expiratory volume in 1 second (FEV1) < 50% of predicted and forced vital capacity (FVC) < 50% of predicted each had significantly higher mortality within the first 5 years post-transplant (p < 0.0001 and p=0.0001, respectively) compared to patients with FEV1 or FVC 50-70% or > 70% (Figure 1). FEV1/FVC < 0.7 and DLCO < 60% predicted were not associated with increased mortality. FEV1 and FVC below 50% of predicted both had longer lengths of stay (p=0.0005 for FEV1 and <0.0001 for FVC), but were not associated with more time on the ventilator. After adjusting for male gender, age, body mass index, smoking history, COPD, creatinine, albumin, and total bilirubin, either FEV1 or FVC < 50% remained independent predictors of mortality with a hazard ratio of 2.65 (p < 0.0001, 95% CI 1.6, 4.3). Abnormal pulmonary function (FEV1 or FVC < 50% prior to transplantation is associated with increased mortality and longer length of stay following transplant. [ABSTRACT FROM AUTHOR]

Purpose Small studies suggest increased left ventricular (LV) mass and resting heart rate (HR)are associated with increased mortality following heart transplantation. We aimed to validate these prior findings and determine if resting HR is correlated with increased LV mass. Methods Retrospective chart review was conducted on 326 consecutive patients following heart transplantation at a single transplant center. Spearman correlation coefficient was used to evaluate correlation between HR and LV mass. Transplant free survival was estimated using the Kaplan-Meier method and survival was compared between groups using the log rank test. Results A total of 326 consecutive heart transplant patients between September 2005 and July 2018 were identified. The average age was 53.6 (± 14.3) years old, 238 patients (73%) were male, and the median follow-up time was 3.7 years. The average HR was 93 (12) beats per minute (BPM) at 1 month and 95 (12) BPM at 1 year. The average LV mass index was 87.1 g/m2 (21.8) at 1 month and 79.2 g/m2 (17.6) at 1 year. No correlation was present between HR and LV mass at 1 month (r=-0.25) or 1 year (r=-0.07). Stratification by resting HR at 1 year (HR ≥ 90 vs < 90) did reveal a trend toward reduced transplant-free survival in patients with an elevated HR (p=0.08) (Figure). Low LV mass index (<80g/m2) at 1-month post-transplant was associated with significantly reduced transplant-free survival (p=0.024) although this relationship was not present at 1 year. Conclusion Resting HR and LV mass following heart transplant were not correlated in our patient cohort. While a trend toward reduced survival in patients with a HR ≥ 90 bpm at 1 year was present, further research is needed to determine whether treatment targeting HR reduction would result in improved survival. [ABSTRACT FROM AUTHOR]