{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:33:48Z","timestamp":1787236428211,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Cardiac allograft vasculopathy (CAV) remains a leading cause of graft failure after heart transplantation, yet an early, non-invasive risk stratification tool is not available. Artificial intelligence electrocardiography (AI-ECG) can estimate biological heart age, and it has been associated with cardiovascular risk. Its deviation with chronological age, called delta age, and its utility in the prediction of CAV has never been explored. We conducted a retrospective single-center study for heart transplant recipients bridged with Impella 5.5 (Abiomed, Danvers, MA, USA) at Mayo Clinic Florida (2020\u20132023). \u0394Age was calculated at discharge and 1-year post-transplant. The primary outcome was confirmed CAV at 1 year. Univariate and multivariable logistic regression models were used to assess the independent association between the \u0394Age and the development of CAV, with discrimination evaluated by AUC and internally validated via bootstrap resampling (2000 iterations). Fifty patients were reviewed. CAV developed in 13 (26%) patients in 3 years. CAV+ patients had a significantly higher \u0394Age at discharge compared to CAV- patients (median \u22121.0 vs. \u221211.0 years, p = 0.0023) and at 1 year (median +7.0 vs. \u22124.0 years, p = 0.0080). On univariate analysis, \u0394Age at discharge was a significant predictor of the development of CAV (OR 1.084 per year, AUC 0.788). On multivariable adjustment, \u0394Age at discharge remained an independent predictor (adjusted OR 1.138, 95% CI 1.023\u20131.265, p = 0.018, and model AUC 0.859). \u0394Age at discharge is a novel and potential predictor of the development of CAV within 3 years. These findings support the integration of AI-ECG into post-transplant surveillance as a scalable, low-cost tool.<\/jats:p>","DOI":"10.3390\/jcdd13080400","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:57:53Z","timestamp":1787230673000},"page":"400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Discharge AI-ECG-Derived Age and Incidence of Cardiac Allograft Vasculopathy at 3 Years: A Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8908-7512","authenticated-orcid":false,"given":"Andrea","family":"Muniz","sequence":"first","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3057-3200","authenticated-orcid":false,"given":"Yugant","family":"Khand","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3729-9724","authenticated-orcid":false,"given":"Vidit","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2502-6153","authenticated-orcid":false,"given":"Aarti","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4404-0559","authenticated-orcid":false,"given":"Laxmi Raj","family":"Bangari","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surbhi","family":"Dadwal","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devora","family":"Leventhal","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0921-1416","authenticated-orcid":false,"given":"Rohan","family":"Goswami","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1161\/CIR.0000000000001168","article-title":"2023 AHA\/ACC\/ACCP\/ASPC\/NLA\/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"148","author":"Virani","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.jacc.2022.08.751","article-title":"Noninvasive Physiologic Assessment of Cardiac Allograft Vasculopathy Is Prognostic for Post-Transplant Events","volume":"80","author":"Clerkin","year":"2022","journal-title":"J. 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