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Published on: November 7, 2020
Diastolic dysfunction: Prevalence and outcome in liver transplantation candidates
Francis Voet1, Maxim Khalenkow1, Michel De Pauw2
1Department of Gastroenterology and Hepatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Hepatology Research Unit, Department Internal Medicine and Pediatrics, Liver Research Center, Corneel Heymanslaan 10, 9000, Ghent University, Belgium.
Insights
The revised criteria identified diastolic dysfunction (DD) in 6.4% of liver transplant (LT) candidates. Diastolic dysfunction did not significantly impact post-LT survival or major adverse cardiovascular events.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Cirrhotic cardiomyopathy (CCM) is a cardiac complication of cirrhosis, primarily manifesting as diastolic dysfunction (DD).
- Diagnostic criteria for DD were updated in 2019, necessitating a re-evaluation of its prevalence and impact in liver transplantation (LT) candidates.
Purpose of the Study:
- To determine the prevalence of diastolic dysfunction (DD) in liver transplantation (LT) candidates using both original (2005) and revised (2019) criteria.
- To assess the clinical impact of DD on waitlist mortality, LT rates, and post-LT outcomes, including survival and major adverse cardiovascular events.
Main Methods:
- Retrospective analysis of echocardiographic data from 233 adult cirrhotic LT candidates.
- Classification of DD using both the 2005 and 2019 criteria.
- Comparison of clinical characteristics, waitlist mortality, LT rates, and post-LT outcomes between patients with and without DD.
Main Results:
- Prevalence of DD was 72.1% using original criteria and 6.4% using revised criteria.
- Patients with DD by revised criteria were older; other characteristics were similar.
- Waitlist mortality, LT rates, and post-LT survival were comparable between groups, although lower e' lateral values pre-LT correlated with post-LT mortality.
- Major adverse cardiovascular events post-transplantation showed no significant difference between groups.
Conclusions:
- The revised criteria identified a lower prevalence (6.4%) of DD in LT candidates.
- Diastolic dysfunction, as defined by the revised criteria, did not significantly impact overall post-transplant mortality or major adverse cardiovascular events.
Introduction And Objectives:
Cirrhotic cardiomyopathy (CCM) is a cardiac complication of cirrhosis primarily presenting as diastolic dysfunction (DD). The original diagnostic criteria from 2005 were updated in 2019. This retrospective study aimed to determine the prevalence and clinical impact of DD in liver transplantation (LT) candidates.
Materials And Methods:
Data from 233 adult cirrhotic LT candidates were analyzed, and echocardiographic data were used to define DD in all patients using the original criteria and the revised criteria.
Results:
The prevalence of DD was 72,1 % using the original criteria for DD and 6,4 % using the revised criteria. Patients with DD according to the revised criteria were older than those without DD. Other clinical characteristics were similar between groups. Waitlist mortality was 13,3 % in patients with DD versus 9,2 % in patients without DD (NS), according to the revised criteria. A similar percentage of patients with DD (80 %) underwent LT compared to patients without DD (89 %). Post-LT survival rates were comparable between patients with DD (87,3 % by original criteria, 91,7 % by revised criteria) and patients without DD (81,3 % by original and 85,6 % by revised criteria). Notably, lower e' lateral values pre-LT were associated with post-LT mortality. Major adverse cardiovascular events post-transplantation occurred in 16,7 % of patients with pre-LT DD and in 13,9 % of patients without pre-LT DD (NS).
Conclusions:
According to the revised criteria, 6,4 % of LT candidates in this cohort had DD. The presence of DD did not significantly impact overall post-transplant mortality.
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