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Published on: November 7, 2020
Takotsubo cardiomyopathy following liver transplantation: A multicenter cohort study
Abraham J Matar1,2, James Keiler1, Alexandra C Bolognese3
1Division of Transplantation, Department of Surgery, Emory University, Atlanta, Georgia, USA.
Insights
Takotsubo cardiomyopathy (TCM) after liver transplantation (LT) significantly reduces heart function but is often reversible. Most patients recover heart function, and recovery is linked to better long-term survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Gastroenterology
Background:
- Takotsubo cardiomyopathy (TCM) is a stress-induced heart condition.
- Liver transplantation (LT) can be a stressful procedure with potential cardiac complications.
- The incidence and outcomes of TCM post-LT are not well-characterized.
Purpose of the Study:
- To investigate the characteristics and outcomes of patients developing TCM after LT.
- To assess the impact of TCM on left ventricular ejection fraction (LVEF) and overall survival (OS).
- To determine the prognostic significance of LVEF recovery post-TCM in LT recipients.
Main Methods:
- A multicenter study included adult patients who developed TCM post-LT (2008-2023) based on Mayo Clinic criteria.
- Demographic, perioperative, and long-term data were collected and analyzed.
- Echocardiograms assessed LVEF changes, and survival data were tracked.
Main Results:
- Fifty-five patients developed TCM post-LT, with a median time to diagnosis of 4 days.
- TCM was associated with a significant reduction in LVEF (from 64% to 25%).
- Most patients (81.8%) recovered LVEF ≥50% by 84 days, and 1-year/3-year OS were 86.3%/69.4%. LVEF recovery correlated with improved OS.
Conclusions:
- TCM following LT is associated with acute LVEF reduction but generally shows good recovery.
- The majority of LT patients with TCM achieve LVEF recovery, experiencing minimal perioperative mortality.
- Monitoring LVEF recovery is crucial, as lack of recovery predicts worse long-term survival in this population.
Abstract:
Takotsubo cardiomyopathy (TCM) is an acute, stress-mediated, reversible cardiomyopathy that occurs in the absence of hemodynamically significant coronary artery disease. We aimed to investigate the characteristics and outcomes of patients who developed TCM following liver transplantation (LT) in a multicenter study. Adult patients from 6 centers across the United States who developed TCM according to Mayo Clinic criteria following LT between 2008 and 2023 were included. Demographics, perioperative and long-term outcomes, and treatment modalities were assessed. Fifty-five patients were included. The center incidence of TCM ranged from 0.1% to 0.5%. The majority were female (54.5%) and Caucasian (87.2%), and the median age at transplant was 59 years. The primary etiologies for LT were alcohol-associated cirrhosis (49.1%) and metabolic dysfunction-associated steatotic liver disease cirrhosis (21.8%). The median time from LT to TCM diagnosis was 4 days. TCM was associated with a 60.9% reduction in left ventricular ejection fraction (LVEF) from a pretransplant median LVEF of 64.0%-25.0%. The most common treatment for TCM was diuretics (67.3%) and afterload reduction (54.5%), with only 27.3% of patients requiring vasopressor support. At a median follow-up of 31.5 months, 1-year and 3-year overall survivals (OSs) were 86.3% and 69.4%, respectively. A repeat echocardiogram performed at a median of 84 days demonstrated that 45/55 patients (81.8%) had recovered LVEF ≥50%. Patients with LVEF recovery to ≥50% had significantly improved OS compared to those without LVEF recovery >50% (106.4 vs. 12.2 mo, p = 0.001). TCM following LT is associated with a significant reduction in LVEF; however, the majority of patients recover LVEF to >50% with minimal perioperative mortality. Importantly, follow-up assessment of LVEF has significant implications as lack of recovery is associated with worse OS.
