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Takotsubo cardiomyopathy in orthotopic liver transplant recipients: A cohort study using multi-center pooled
Mohammad Zmaili1, Jafar Alzubi2, Motasem Alkhayyat3
1Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
Insights
Takotsubo cardiomyopathy (TCM) is more common in liver transplant recipients. Older age, female sex, Caucasian ethnicity, and arrhythmias predict TCM in these patients.
Area of Science:
- Cardiology
- Transplant Surgery
- Critical Care Medicine
Background:
- Takotsubo cardiomyopathy (TCM), or stress-induced cardiomyopathy, is linked to poor outcomes.
- Limited data indicate an increased peri-operative risk for TCM in orthotopic liver transplant (OLT) recipients.
Purpose of the Study:
- To identify predictors of TCM in OLT recipients.
- Utilized a large, multi-center pooled electronic health database for comprehensive analysis.
Main Methods:
- Surveyed a multi-institutional electronic health record database (Explorys Inc).
- Identified a cohort of OLT patients between 09/2015 and 09/2020.
- Analyzed new TCM diagnoses post-OLT and characterized risk associations using linear regression.
Main Results:
- TCM occurred in 0.3% of OLT recipients versus 0.04% in non-OLT patients (OR: 7.98, P < 0.0001).
- OLT recipients with TCM were more likely to be older (>65 years), Caucasian, and female (P < 0.05).
- A significant association was found with cardiac arrhythmias, particularly ventricular arrhythmias (P < 0.0001).
Conclusions:
- TCM is significantly more prevalent in liver transplant recipients compared to non-recipients.
- Predictors for TCM in liver transplant recipients include older age, Caucasian ethnicity, female gender, and the presence of arrhythmias.
Background:
Takotsubo cardiomyopathy (TCM), or stress-induced cardiomyopathy, is associated with adverse prognosis. Limited data suggest that TCM occurring in orthotopic liver transplant (OLT) recipients is associated with elevated peri-operative risk.
Aim:
To characterize the predictors of TCM in OLT recipients, using a large, multi-center pooled electronic health database.
Methods:
A multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of de-identified electronic health record data from 26 United States healthcare systems was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of "liver transplant" between 09/2015 and 09/2020 was identified. Subsequently, individuals who developed a new diagnosis of TCM following OLT were identified. Furthermore, the risk associations with TCM among this patient population were characterized using linear regression.
Results:
Between 09/2015 and 09/2020, of 37718540 patients in the database, 38740 (0.10%) had a history of OLT (60.6% had an age between 18-65 years, 58.1% female). A new diagnosis of TCM was identified in 0.3% of OLT recipients (45.5% had an age between 18-65 years, 72.7% female), compared to 0.04% in non-OLT patients [odds ratio (OR): 7.98, 95% confidence intervals: 6.62-9.63, (P < 0.0001)]. OLT recipients who developed TCM, compared to those who did not, were more likely to be greater than 65 years of age, Caucasian, and female (P < 0.05). There was also a significant association with cardiac arrhythmias, especially ventricular arrhythmias (P < 0.0001).
Conclusion:
TCM was significantly more likely to occur in LT recipients vs non-recipients. Older age, Caucasian ethnicity, female gender, and presence of arrhythmias were significantly associated with TCM in LT recipients.
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