Chronotropic incompetence in end-stage liver disease

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Cirrhosis affects cardiovascular and autonomic systems, leading to cirrhotic cardiomyopathy (CCM).
• CCM involves cardiac dysfunction and electrophysiological abnormalities like chronotropic incompetence (CI).
• CI, a feature of autonomic neuropathy in cirrhosis, is common in liver disease.

Purpose of the Study:

• To evaluate the utility of cardiac exercise stress testing in diagnosing CCM.
• To assess the prevalence and characteristics of CI in end-stage liver disease (ESLD) patients.

Main Methods:

• 160 ESLD patients undergoing orthotopic liver transplantation (OLT) had cardiac exercise stress tests.
• Chronotropic incompetence (CI) was defined by the inability to achieve heart rate reserve (HRR).
• Impact of beta-blocker therapy on HRR was analyzed.

Main Results:

• 68.8% of patients exhibited CI, more prevalent in severe ESLD (higher MELD/Child-Pugh scores).
• Alcoholic cirrhosis patients showed lower heart rates and reduced heart rate reserve compared to other etiologies.
• CI presence did not significantly impact OLT recipient survival.

Conclusions:

• CI is highly prevalent in liver transplant candidates, exceeding previous estimates.
• Cardiac exercise stress testing is a reliable tool for diagnosing CCM in OLT candidates.
• CI's correlation with liver disease severity exists, but it doesn't affect long-term OLT survival.