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Diastolic Dysfunction in Liver Cirrhosis: Prognostic Predictor in Liver Transplantation?
F Carvalheiro1, C Rodrigues2, T Adrego3
1Department of Anesthesia, Centro Hospitalar do Algarve, Portimão, Portugal.
Insights
Diastolic dysfunction (DD) is common in liver cirrhosis patients before liver transplantation (LT). This cardiac condition, along with a prolonged QTc interval, can increase mortality risk after LT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Liver cirrhosis can lead to cirrhotic cardiomyopathy (CC).
- CC is marked by impaired contractile response to stress, diastolic dysfunction (DD), and electrical abnormalities.
- These cardiac issues can negatively impact patient prognosis.
Purpose of the Study:
- To analyze the prevalence of diastolic dysfunction (DD) and prolonged QTc interval in patients with liver cirrhosis awaiting liver transplantation (LT).
- To investigate the correlation between these cardiac abnormalities and post-LT outcomes, including mortality.
Main Methods:
- Retrospective analysis of 106 patients undergoing LT between January 2012 and June 2015.
- Evaluation of demographic data, cirrhosis etiology, Child-Pugh and MELD scores, preoperative QTc interval, and cardiac function (systolic and diastolic).
- Statistical comparison of DD and QTc prolongation with MELD/Child-Pugh scores and post-LT outcomes using chi-square, Fisher, and Mann-Whitney U tests.
Main Results:
- The study included 106 patients (80.2% male, average age 54.83 years).
- Prevalence of prolonged QTc was 19% and DD was 35.8%.
- No significant association was found between QTc prolongation or DD and MELD or Child-Pugh scores.
Conclusions:
- A significant incidence of diastolic dysfunction (DD) was observed in patients pre-LT, indicating a predisposition to adverse cardiac events.
- The presence of DD is associated with increased mortality following liver transplantation in patients with hepatic cirrhosis.
Background:
Patients with liver cirrhosis may develop cirrhotic cardiomyopathy (CC), characterized by blunted contractile responsiveness to stress, diastolic dysfunction (DD), and electrophysiological abnormalities. It may adversely affect the long-term prognosis of these patients.
Methods:
We conducted a retrospective analysis of patients undergoing liver transplantation (LT) for cirrhosis from January 2012 to June 2015. We analyzed demographic characteristics, the etiology of cirrhosis, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, the corrected QT (QTc) interval in the preoperative period, diastolic and systolic dysfunction, mortality and survival, and duration of mechanical ventilation and vasopressor support in the post-LT period. These variables were compared with diastolic dysfunction and prolongation of QTc, with the use of chi-square, Fisher, and Mann-Whitney U tests.
Results:
The study included 106 patients, 80.2% male and overall average age 54.83 years. The median MELD score was 16, and Child-Pugh class C in 55.4%. Prolonged QTc interval before LT was present in 19% and DD in 35.8% of patients. QTc before LT or DD did not vary significantly with MELD or Child-Pugh score.
Conclusions:
The patients in the pre-LT period presented with a significant incidence of DD, which can predispose them to adverse cardiac events. The presence of DD correlates with mortality after LT in patients with hepatic cirrhosis.
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