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ISSN: 2392-1099
Clinical and Experimental Hepatology
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4/2021
vol. 7
 
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abstract:
Original paper

Impact of left ventricular diastolic dysfunction on liver transplantation outcomes based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations

Hemnishil K. Marella
1
,
Neeraja Yedlapati
2
,
Jiten P. Kothadia
1
,
Vamsee K Mupparaju
3
,
Saisindhu Marella
4
,
Satheesh P. Nair
1

  1. Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee, USA
  2. Division of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  3. Methodist Le Bonheur Healthcare, Memphis, Tennessee, USA
  4. University of Louisville, College of Medicine, Louisville, Kentucky, USA
Clin Exp HEPATOL 2021; 7, 4 390-395
DOI: https://doi.org/10.5114/ceh.2021.111001
Online publish date: 2021/11/26
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Introduction
Cirrhotic cardiomyopathy encompasses systolic dysfunction, left ventricular diastolic dysfunction (LVDD), and conduction abnormalities. This study aims to investigate the impact of LVDD on mortality in patients undergoing liver transplantation (LT).

Material and methods
A retrospective review of 400 consecutive patients who underwent LT at our institution was performed. Patient demographics, clinical data, and transthoracic echocardiogram (TTE) were reviewed to identify LVDD. The total cohort consisted of 266 patients after excluding patients with insufficient TTE data (n = 56), patients with indeterminate LVDD (n = 71), and patients with ejection fraction (EF) < 55% (n = 7). Statistical analysis was performed using descriptive statistics. Cox regressions with hazard ratios (HRs) and 95% confidence intervals (CI) were applied to predict 5-year all-cause mortality. Kaplan-Meier survival analysis was conducted to understand the impact of LVDD on 5-year all-cause mortality.

Results
Patients with LVDD have higher incidence of hyperlipidemia (36% vs. 17%, p = 0.003), hypertension (50% vs. 27%, p = 0.001) and diabetes (52% vs. 30%, p = 0.003). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 24%, p = 0.001). A multivariate logistic regression analysis was performed with age, body mass index (BMI), NASH, alcoholic cirrhosis, hepatitis C, history of diabetes, history of hyperlipidemia, and history of hypertension. In this multivariate logistic regression analysis, NASH (odds ratio [OR] = 4.43 [1.10-17.8], p = 0.04), and history of hypertension (OR = 2.33 [1.16-4.66], p = 0.01) were independent predictors of LVDD. The Kaplan-Meier survival analysis and multivariate Cox regression demonstrated that the presence of LVDD had no impact on 5-year all-cause mortality (log-rank test nonsignificant).

Conclusions
This study indicates that LVDD in end-stage liver disease (ESLD) patients does not affect immediate post-transplant outcomes or 5-year all-cause mortality.

keywords:

left ventricular diastolic dysfunction, non-alcoholic steatohepatitis, cirrhosis, liver transplant, cirrhotic cardiomyopathy
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