Diastolic Dysfunction in Patients With End-Stage Liver Disease is Associated With Development of Heart Failure Early After Liver Transplantation

Dowsley, Taylor F.; Bayne, David; Langnas, Alan Norman; Dumitru, Ioana; Windle, John R.; Porter, Thomas R.; Raichlin, Eugenia

doi:10.1097/tp.0b013e31825f0f97

Cited by 90 publications

(87 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, studies which have used clinical and radiological, but not solely echocardiographic, criteria to diagnose post-OLT HF report an incidence threefold higher than ours. 7,8 However, with the large fluid shifts and systemic inflammation seen with OLT, the effects of In the absence of acute ischemia or apparent stress.…”

Section: Discussionmentioning

confidence: 99%

“…They report incidences ranging from 7% to 27%, depending on the definition of HF and its time of occurrence. [6][7][8] Systolic HF after OLT is a poorly understood entity and may potentially result from a multitude of etiologies. There is paucity of knowledge on predictors of systolic HF occurring soon after OLT, the clinical course of these patients, and prospect for recovery of systolic function.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Sonny

Govindarajan

Jaber

et al. 2018

Clinical Transplantation

View full text Add to dashboard Cite

Although most patients presenting for liver transplantation have normal left ventricular function, some develop left ventricular failure after transplantation. The primary objective of our study was to determine the predictors of systolic heart failure (HF) occurring immediately after liver transplantation. Its etiology, prospects of recovery, and factors associated with nonrecovery were also studied. Liver transplantations performed at our institution from January 2006 to February 2015 were evaluated using prospectively collected institutional registries. Patients with echocardiographically documented decline in ejection fraction to <45% within 6 months after liver transplantation were identified. Four controls were chosen per case: matched for age, gender, transplant year, and model for end-stage liver disease score. Conditional multivariable logistic regression was used for primary analysis and nonparametric tests for comparison between groups. In a cohort of 1284 adult patients, 45 cases and 180 controls were identified. Diastolic dysfunction (DD) was an independent predictor (OR 5.26, 95% CI 1.03-28.57, P = .04) of systolic HF in multivariable analysis. Stress-induced cardiomyopathy was the most common etiology. Left ventricular function recovered in 21 patients. Pretransplant DD decreased the chances of recovery (P = .05). In conclusion, patients with pretransplant DD need close post-transplant follow-up for timely identification of HF.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sonny

Govindarajan

Jaber

et al. 2018

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…Some echocardiographic indices of preorthotopic liver transplantation (OLT) DD have been associated with post-OLT heart failure. 4,5 An e/a <1 is known to be an independent predictor of mortality after placement of transjugular intrahepatic | 987 portosystemic shunt. 6 Also some studies have found an association between DD and post-OLT mortality while others have found no association.…”

Section: Introductionmentioning

confidence: 99%

“…6 Also some studies have found an association between DD and post-OLT mortality while others have found no association. 4,[7][8][9] However, most of these investigations have defined DD based on only one or two echocardiographic parameters, likely adding error to estimation of DD. For instance, e/a is load-dependent parameter, and thus by itself a poor indicator of the grade of DD.…”

Section: Introductionmentioning

confidence: 99%

Impact and persistence of cirrhotic cardiomyopathy after liver transplantation

Sonny

Ibrahim

Schuster

et al. 2016

Clinical Transplantation

View full text Add to dashboard Cite

Cirrhotic cardiomyopathy causes variable degree of systolic and diastolic dysfunction (DD) and conduction abnormalities. The primary aim of our study was to determine whether pre-transplant DD and prolonged corrected QT (QTc) predict a composite of mortality, graft failure, and major cardiovascular events after liver transplantation. We also evaluated the reversibility of cirrhotic cardiomyopathy after transplantation. Adult patients who underwent liver transplantation at our institution from January 2007 to March 2009 were included. Data were obtained from institutional registry, medical record review, and evaluation of echocardiographic images. Among 243 patients, 113 (46.5%) had grade 1 DD, 16 (6.6%) had grade 2 DD, and none had grade 3 DD. The mean pre-transplant QTc was 453 milliseconds. After a mean post-transplant follow-up of 5.2 years, 75 (31%) patients satisfied the primary composite outcome. Cox regression analysis did not show any significant association between DD and the composite outcome (P=.17). However, longer QTc was independently associated with the composite outcome (HR: 1.01, 95% confidence interval: 1.00-1.02, P=.05). DD (P<.001) and left ventricular mass index (P=.001) worsened after transplantation. In conclusion, QTc prolongation appears to be associated with worse outcomes. Although DD did not impact outcomes, it significantly worsened after transplantation.

show abstract

“…Josefsson et al [25] found it to be associated with a longer ITU stay (14.5 d vs 4 d), a longer inpatient stay (33 d vs 21 d), a higher peri-transplant infection rate (42% vs 19.9%) and higher long term patient and graft mortalities (Figure 10). In a search to identify predictors of heart failure after liver transplantation, Dowsley et al [92] found that markers of diastolic dysfunction on preoperative TTE (E/e' > 10 and LA volume index ≥ 40 mL/m 2 ) were associated with a 3.4 fold and 2.9 fold increase in risk respectively. Furthermore, Kaplan-Meier analysis of LA volume index below and above 40 mL/m 2 revealed survival differences of 82% vs 54% at 1 year and 71% vs 50% at 5 years respectively.…”

Section: Post Operative Coursementioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

View full text Add to dashboard Cite

Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation of the myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of the β-adrenergic receptor. Diagnosis can be made using a combination of echocardiography (resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. Core tip: Cirrhotic cardiomyopathy is characterised by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation and prolongation of the QT interval. It is only recently that it has been recognised as a definitive clinical entity, and yet it has significant implications in a number of clinical situations in which there is increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Liver transplantation is one such situation, and in this review we discuss criteria for diagnosis, possible methods to limit further deterioration and the perioperative management of these patients.

show abstract

Diastolic Dysfunction in Patients With End-Stage Liver Disease is Associated With Development of Heart Failure Early After Liver Transplantation

Abstract: 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.

Cited by 90 publications

References 26 publications

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

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

Impact and persistence of cirrhotic cardiomyopathy after liver transplantation

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Contact Info

Product

Resources

About