Preoperative left ventricular hypertrophy is associated with reduced patient survival after liver transplantation

Darstein, Felix; König, Christina; Hoppe‐Lotichius, Maria; Grimm, Dorothee; Knapstein, Johanna; Mittler, Jens; Zimmermann, Arthur; Otto, G.; Lang, Hauke; Galle, Peter R.; Zimmermann, Tim

doi:10.1111/ctr.12304

Cited by 22 publications

(17 citation statements)

References 39 publications

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“…Since, cardiac dysfunction in cirrhosis seems not to be associated with the severity of liver disease [27], both an accurate patient selection for liver transplant [28,29] and a precise investigation for cirrhotic cardiomyopathy are mandatory. Indeed, cirrhotic cardiomyopathy may influence the outcome after liver transplantation [30][31][32]; moreover, liver transplantation may be responsible for additional intra-and postoperative short-and long-term cardiac morbidity [33].…”

Section: Pre-transplant Investigative Methodsmentioning

confidence: 99%

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Zardi

Chin

et al. 2016

Journal of Cardiology

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Patients with advanced liver cirrhosis may develop a clinical syndrome characterized by a blunted contractile responsiveness to stress and/or altered diastolic relaxation, called "cirrhotic cardiomyopathy." This syndrome, which is initially asymptomatic, is often misdiagnosed due to the presence of symptoms that characterize other disorders present in patients with advanced liver cirrhosis, such as exercise intolerance, fatigue, and dyspnea. Stress and other conditions such as liver transplantation and transjugular intrahepatic portosystemic shunt (TIPS) may unmask this syndrome. Liver transplantation in this group of patients results in a clinical improvement and can be a cure for the cardiomyopathy. However, post-transplant prognosis depends on the identification of cirrhotics with cardiomyopathy in the pre-transplant phase; an early diagnosis of cirrhotic cardiomyopathy in the pre-transplant phase may avoid an acute onset or worsening of cardiac failure after liver transplantation. Since a preserved left ventricular ejection fraction may mask the presence of cirrhotic cardiomyopathy, the use of newer noninvasive diagnostic techniques (i.e. tissue Doppler, myocardial strain) is necessary to identify cirrhotics with this syndrome, in the pre-transplant phase. A pre-transplant treatment of heart failure in cirrhotics with cardiomyopathy improves the quality of life in this phase and reduces the complications during and immediately after liver transplantation. Since specific therapies for cirrhotic cardiomyopathy are lacking, due to the absence of a clear understanding of the pathophysiology of the cardiomyopathy, further research in this field is required.

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Section: Pre-transplant Investigative Methodsmentioning

confidence: 99%

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Zardi

Chin

et al. 2016

Journal of Cardiology

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“…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

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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.

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“…(5) The presence of diastolic dysfunction could be involved in hepatorenal syndrome (HRS) and in the morbidity of some of the major procedures, such as surgery, TIPS, and liver transplantation. (6)(7)(8) However, because diagnostic criteria for CCMP are not usually used in routine, its prevalence in this population and the incidence of post-TIPS cardiac decompensation are not well known. A better evaluation of the risk of post-TIPS cardiac decompensation should improve the patient's selection and help to prevent congestive heart failure.…”

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confidence: 99%

A Prospective Study Identifying Predictive Factors of Cardiac Decompensation After Transjugular Intrahepatic Portosystemic Shunt: The Toulouse Algorithm

et al. 2019

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Background and Aims Transjugular intrahepatic portosystemic shunt (TIPS) is now a standard for the treatment of portal hypertension–related complications. After the TIPS procedure, incidence and risk factors of cardiac decompensation are poorly known. The main objectives were to measure the incidence of the onset of cardiac decompensation after TIPS and identify the predictive factors. Approach and Results All patients with cirrhosis treated with TIPS between May 2011 and June 2016 were considered for inclusion. They received a cardiac assessment by standard biological parameters, transthoracic echocardiography, and right heart catheterization. Patients were followed for 1 year after TIPS insertion. The main endpoint was the incidence of cardiac decompensation requiring hospitalization. One hundred seventy‐four patients were treated by TIPS during the period. One hundred patients who underwent a complete cardiac evaluation were included. A cardiac decompensation occurred in 20% of the patients. The parameters associated with the occurrence of severe cardiac decompensation were a prolonged QT interval corrected (462 vs. 443 ms; P = 0.05), an elevated pre‐TIPS brain natriuretic peptide (BNP) or N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level, an elevated E/A ratio (1.5 vs. 1.0; P = 0.001) and E/e′ ratio (11 vs. 7; P < 0.001), and a left atrial dilatation (40 vs. 29 mL/m2; P = 0.011). The presence of aortic stenosis was also associated with cardiac decompensation. A level of BNP <40 pg/mL and NT‐proBNP <125 pg/mL allowed identifying patients without risk of cardiac decompensation. Additionally, absence of diastolic dysfunction criteria at echocardiography ruled out the risk of further cardiac decompensation. Conclusions Hospitalization for cardiac decompensation is observed in 20% of patients in the year after TIPS insertion. Combining BNP or NT‐proBNP levels and echocardiographic parameters should help improve patient selection.

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Preoperative left ventricular hypertrophy is associated with reduced patient survival after liver transplantation

Abstract: LVH is frequently diagnosed in patients on the waiting list and influences survival after LT.

Cited by 22 publications

References 39 publications

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Impact and persistence of cirrhotic cardiomyopathy after liver transplantation

A Prospective Study Identifying Predictive Factors of Cardiac Decompensation After Transjugular Intrahepatic Portosystemic Shunt: The Toulouse Algorithm

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