Faculty Collaboration Database

Diastolic dysfunction in patients with end-stage liver disease is associated with development of heart failure early after liver transplantation. Transplantation 2012 Sep 27;94(6):646-51

Date

08/25/2012

Pubmed ID

22918216

DOI

10.1097/TP.0b013e31825f0f97

Scopus ID

2-s2.0-84866731415 (requires institutional sign-in at Scopus site)   80 Citations

Abstract

BACKGROUND: Liver transplantation (LTx) is a life-saving treatment of end-stage liver disease. Cardiac complications including heart failure (HF) are among the leading causes of death after LTx.

THE AIM: The aim is to identify clinical and echocardiographic predictors of developing HF after LTx.

METHODS: Patients who underwent LTx at the University of Nebraska Medical Center (UNMC) between January 2001 and January 2009 and had echocardiographic study before and within 6 months after transplantation were identified. Patients with coronary artery disease (>70% lesion) were excluded. HF after LTx was defined by clinical signs, symptoms, radiographic evidence of pulmonary congestion, and echocardiographic evidence of left ventricular dysfunction (left ventricle ejection fraction <50%).

RESULTS: Among 107 patients (presented as mean age [SD], 55 [10] years; male, 70%) who met the inclusion criteria, 26 (24%) patients developed HF after LTx. The pre-LTx left ventricle ejection fraction did not differ between the HF (69 [7]) and the control groups (69 [7] vs. 67 [6], P=0.30). However, pre-LTx elevation of early mitral inflow velocity/mitral annular velocity (P=0.02), increased left atrial volume index (P=0.05), and lower mean arterial pressure (P=0.03) were predictors of HF after LTx in multivariate analysis. Early mitral inflow velocity/mitral annular velocity greater than 10 and left atrial volume index 40 mL/m2 or more were associated with a 3.4-fold (confidence interval, 1.2-9.4; P=0.017) and 2.9-fold (confidence interval, 1.1-7.5; P=0.03) increase in risk of development of HF after LTx, respectively.

CONCLUSIONS: This study suggests that elevated markers of diastolic dysfunction during pre-LTx echocardiographic evaluation are associated with an excess risk of HF and may predict post-LTx survival.

Author List

Dowsley TF, Bayne DB, Langnas AN, Dumitru I, Windle JR, Porter TR, Raichlin E

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Aged
Arterial Pressure
Case-Control Studies
Diastole
Echocardiography, Doppler
Female
Heart Atria
Heart Failure
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic
Linear Models
Liver Transplantation
Male
Middle Aged
Mitral Valve
Multivariate Analysis
Nebraska
Predictive Value of Tests
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left
Ventricular Function, Left