Acute heart failure after liver transplantation: A narrative review

Abstract

Acute heart failure (AHF) is present in a substantial proportion of patients after liver transplantation (LT), and is associated with significant morbidity and mortality. 1-4 The pretransplant hemodynamic changes (decreased systemic vascular resistance (SVR), poor ventricular response to stress and increased cardiac output) that occur in patients with end-stage liver disease (ESLD) coupled with the effects of pro-inflammatory cytokines released during reperfusion of the liver during transplantation have been implicated in both systolic and diastolic dysfunction, contributing to AHF. 5 Both ischemic and non-ischemic causes have been implicated. While ischemic heart disease, has well defined risk factors, and may be identified preoperatively, non-ischemic AHF, is a poorly understood entity and can occur in the absence of obvious risk factors. Standard preoperative workup including electrocardiogram (EKG), echocardiography at rest or on stress, or biomarkers has limitations in predicting this risk. Cirrhotic cardiomyopathy, iron overload cardiomyopathy, and stress-induced cardiomyopathy are some of the commonly implicated entities. Distinguishing one etiology from the other is difficult and multiple etiologies may coexist in the same patient. While early recognition of risk factors and diagnosis is difficult, once diagnosed, there are no clear-cut rules for candidacy of transplant in these patients and no guidelines exist to help optimize these patients prior to transplant. These patients are at a high-risk of cardiovascular collapse either during the intraoperative period or in the immediate postoperative period and approaches to mitigate these risks as

Characteristics, Risk Factors, and Outcome of New-onset Systolic Heart Failure After Liver Transplantation: A Single-center Cohort

“…Although the majority of the aforementioned risk factors are nonmodifiable, their presence should trigger active surveillance for acute HF so that treatment can be instituted as early as possible. 7,14…”

“…Although the majority of the aforementioned risk factors are nonmodifiable, their presence should trigger active surveillance for acute HF so that treatment can be instituted as early as possible. 7,14 This study is limited by its retrospective single-center nature, which is based on an electronic review of medical records. The decision to perform echocardiography was based on clinical judgment; hence, not all patients underwent echocardiography during the first 12 mo after LT.…”

“…Regrettably, 2 decades of research into the diagnostic, therapeutic, and preventive strategies of post-LT myocardial dysfunction have provided scant data regarding its etiology, characteristics, and prognosis. 6,7 Thus, there remains a dire need to fill this knowledge gap so that the loss of both lives and grafts can be minimized.…”

“…9 Although several etiologies and predictors of HF after LT has been proposed, 3,5,10 these reports mainly focused on early nonischemic systolic LV dysfunction and overlooked the roles of ischemic etiologies and RV in post-LT HF. [3][4][5]7,[10][11][12][13][14] An additional understanding of cardiac dysfunction after LT is…”

The effect of narrative persuasion on interpersonal talk and attitude (the case of COVID-19)

“…Corinna Oschatz et al (2022) found that the presence of an example increases the engagement of the audience with the narrative, which indirectly has a positive effect on the attitude and behavior of the audience. Sharma et al (2020) also studied 118 media students at the Western University of…”