Global Longitudinal Strain at Rest as an Independent Predictor of Mortality in Liver Transplant Candidates: A Retrospective Clinical Study

Abstract

Speckle tracking echocardiography enables the detection of subclinical left ventricular dysfunction at rest in many heart diseases and potentially in severe liver diseases. It could also possibly serve as a predictor for survival. In this study, 117 patients evaluated for liver transplantation in a single center between May 2010 and April 2016 with normal left ventricular ejection fraction were included according to clinical characteristics of their liver disease: (1) compensated (n = 29), (2) clinically significant portal hypertension (n = 49), and (3) decompensated (n = 39). Standard echocardiography and speckle tracking echocardiography were performed at rest and during dobutamine stress. Follow-up amounted to three years to evaluate survival and major cardiac events. Altogether 67% (78/117) of the patients were transplanted and 32% (31/96 patients) died during the three-year follow-up period. Global longitudinal strain (GLS) at rest was significantly increased (became more negative) with the severity of liver disease (p < 0.001), but reached comparable values in all groups during peak stress. Low (less negative) GLS values at rest (male: >−17/female: >−18%) could predict patient survival in a multivariate Cox regression analysis (p = 0.002). GLS proved valuable in identifying transplant candidates with latent systolic dysfunction.

Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease

“…Our results indicate significantly elevated GLS for ESLD patients, while LVEF values were unaltered. Data on GLS in cirrhotic patients with normal LVEF are limited and conflicting [ 17 , 18 , 19 , 20 ]. Mechelinck et al recently reported that both low and high GLSs occur in ELSD patients and are both negative prognostic factors [ 20 ].…”

“…Data on GLS in cirrhotic patients with normal LVEF are limited and conflicting [ 17 , 18 , 19 , 20 ]. Mechelinck et al recently reported that both low and high GLSs occur in ELSD patients and are both negative prognostic factors [ 20 ]. While a reduced GLS represented a subclinical systolic dysfunction, an increased GLS was associated with more advanced liver diseases [ 20 ].…”

“…Mechelinck et al recently reported that both low and high GLSs occur in ELSD patients and are both negative prognostic factors [ 20 ]. While a reduced GLS represented a subclinical systolic dysfunction, an increased GLS was associated with more advanced liver diseases [ 20 ]. Supporting this finding, we established a correlation of LV GLS with various liver-specific laboratory markers and MELD score.…”

Prevalence and prognostic value of cirrhotic cardiomyopathy as defined according to the proposed new classification

“…between Child-Pugh A, B, and C grade cirrhosis) [21][22][23] or an increased GLS at rest (i.e. higher LV contractility) in more advanced liver disease (Child-Pugh C) correlating with a worse prognosis [24,25]. In the newly proposed classification a GLS < 18% and > 22% has been considered diagnostic of CCM [7].…”

Cirrhotic Cardiomyopathy

“…Current investigations aim to determine whether GLS can be used as a new diagnostic criterion for reduced systolic function. For patients with known heart failure with preserved ejection fraction, reduced GLS is a predictor of adverse events [35].…”