An observational study presented at the Heart Failure Society of America annual meeting and published in JACC: Heart Failure suggests that high pulmonary vascular resistance (PVR) alone should not disqualify patients from heart transplantation. Analyzing 42,845 adult recipients of primary isolated heart transplants from 2005 to 2025, the researchers found that recipients with high PVR but normal transpulmonary gradient (TPG) did not have significantly higher 1-year mortality (adjusted HR 1.06, 95% CI 0.92-1.23) than those with both low PVR and low TPG. In contrast, elevated TPG was associated with excess mortality whether PVR was low (adjusted HR 1.15) or high (adjusted HR 1.18).
PVR is a calculated value, TPG divided by cardiac output, while TPG is the measured pressure drop across the lungs. The authors argue that in low-output heart failure, PVR can be mathematically elevated without fixed pulmonary vascular disease, and in LVAD-supported patients, high output can make PVR falsely reassuring. As continuous variables, rising PVR did not track with rising mortality, while rising TPG did.
Commentary was mixed. The presenter, Ahmed Zayed, said the goal is not to discard PVR but to stop reading it in isolation. Maya Guglin of Rutgers Health agreed the two measures should be used as complements, but said the paper lacks absolute pulmonary artery pressures and does not provide enough evidence to change current practice. Both experts noted that PVR and TPG should be considered together, though they differed on whether this study should alter clinical decisions.