Clinical predictors of post-liver transplant new-onset heart failure

Abstract

Objectives of this study were (1) to evaluate preoperative predictors of systolic and diastolic heart failure in patients undergoing liver transplantation (LT) and (2) to describe the prognostic implications of systolic and diastolic heart failure in these patients. The onset of heart failure after orthotopic LT remains poorly understood. Data were obtained for all LT recipients between January 2000 and December 2010. The primary outcome was post-LT heart failure: systolic (ejection fraction 50%), diastolic, or mixed heart failure. Patients underwent echocardiographic evaluation before and after LT. Pretransplant variables were evaluated as predictors of heart failure with Cox proportional hazards model. 970 LT recipients were followed for 5.3 6 3.4 years. Ninety-eight patients (10.1%) developed heart failure in the posttransplant period. There were 67 systolic (6.9%), 24 diastolic (2.5%), and 7 mixed systolic/diastolic (0.7%) heart failures. Etiology was ischemic in 18 (18.4%), tachycardia-induced in 8 (8.2%), valvular in 7 (7.1%), alcohol-related in 4 (4.1%), hypertensive heart disease in 3 (3.1%), and nonischemic in majority of patients (59.2%). Pretransplant grade 3 diastolic dysfunction, diabetes, hypertension, mean arterial pressure 65 mm Hg, mean pulmonary artery pressure 30 mm Hg, mean pulmonary capillary wedge pressure 15 mm Hg, hemodialysis, brain natriuretic peptide level and QT interval > 450 ms were found to be predictive for the development of new-onset systolic heart failure. However beta-blocker use before LT and tacrolimus after LT were associated with reduced development of new-onset systolic heart failure. In conclusion, pretransplant risk factors, hemodynamic variables, and echocardiographic variables are important predictors of post-LT heart failure. In patients undergoing LT, postoperative onset of systolic or diastolic heart failure was found to be an independent predictor of mortality.

Systolic heart failure after liver transplantation: Incidence, predictors, and outcome

“…The incidence of systolic HF after OLT reported in our study is similar to that reported by others . Qureshi et al reported an incidence of 7% among 970 patients after a median follow‐up of 5 years, a quarter among who developed HF within a week of OLT. In their study, the presence of grade 3 DD and certain cardiovascular risk factors (hypertension and diabetes) before OLT were associated with systolic HF.…”

“…Calcineurin inhibitors, a common antirejection medication used after OLT, have been associated with DD . On the other hand, preoperative beta blocker use was found to be protective for HF after OLT …”

“…Studies looking at post‐OLT HF, groups together systolic and diastolic HF occurring at varying duration of time after OLT. They report incidences ranging from 7% to 27%, depending on the definition of HF and its time of occurrence …”

Reversible non‐ischaemic cardiomyopathy and left ventricular dysfunction after liver transplantation: a single‐centre experience

“…Qureshi et al . has recently reported that a QTc interval >450 is a predictor of post‐LT systolic heart failure .…”

Reply

“…Moreover, we did not find coronary artery disease or elevated blood pressure to be a significant risk factor for heart failure in this population. 4 Seventeen cases developed heart failure within the first 30 days, and 9 cases (>50%) suffered from perioperative myocardial infarction. Only 12 of these 17 cases developed systolic heart failure, and they eventually included all 9 cases with perioperative myocardial infarction.…”