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A Clinical-Imaging Score Reclassifies Indeterminate Diastolic Dysfunction and Predicts Posttransplant Cardiac Events
Jae Hyon Park1,2, Eun-Ki Min3, June Park1
1Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Insights
A new risk score combining liver stiffness from MRE and NT-proBNP effectively identifies diastolic dysfunction (DD) in liver cirrhosis patients, improving prediction of major adverse cardiac events after liver transplantation.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Left ventricular diastolic dysfunction (DD) is prevalent in liver cirrhosis (LC) patients, impacting transplant outcomes.
- Predicting post-liver transplantation (LT) major adverse cardiac events (MACE) is crucial.
Purpose of the Study:
- Develop a simple clinical risk score using magnetic resonance elastography (MRE) and biomarkers.
- Identify DD and enhance MACE prediction in LC patients undergoing LT.
Main Methods:
- Retrospective analysis of 114 LC patients with pre-LT MRE and echocardiography.
- Identified independent predictors of DD using logistic regression.
- Developed and validated a composite DD risk score.
Main Results:
- Higher NT-proBNP and MRE liver stiffness predicted DD.
- The risk score improved DD identification and MACE prediction.
- The score reclassified indeterminate DD cases, increasing prevalence to 18.4% and significantly associating with MACE.
Conclusions:
- A risk score integrating MRE liver stiffness and NT-proBNP enhances DD detection.
- This score improves prognostication of post-LT MACE.
- It serves as a valuable tool for patients with equivocal DD on echocardiography.
Introduction:
Left ventricular diastolic dysfunction (DD) is a common cardiac abnormality in patients with liver cirrhosis (LC), associated with adverse peri-and posttransplant outcomes. We aimed to develop a simple clinical risk score incorporating magnetic resonance elastography (MRE) and biomarkers to identify DD and improve prediction of post-liver transplantation (LT) major adverse cardiac events (MACE).
Methods:
This retrospective study analyzed 114 LC patients who underwent pre-LT MRE and transthoracic echocardiography (TTE) between 2019 and 2025. Patients with structural heart disease or confounding comorbidities were excluded. Clinical, laboratory, and imaging parameters were analyzed. Independent predictors of DD were identified using logistic regression, and a composite DD risk score was developed. Predictive ability for 1-year post-LT MACE was assessed with and without reclassification of indeterminate cases.
Results:
The prevalence of DD by TTE was 14.0%. Higher NT-proBNP and liver stiffness on MRE were independent predictors of DD. A composite risk score was derived as (NT-proBNP/50) + (4 × MRE stiffness). Using a cutoff ≥61 points, the score achieved 92% specificity. Among patients with indeterminate DD (35.9% of the cohort), 12.2% were classified as DD using the risk score, raising the prevalence to 18.4%. Incorporating the score improved discrimination of 1-year post-LT MACE (p < 0.001). DD classified by TTE plus risk score was independently associated with MACE (odds ratio [OR], 5.77, p = 0.002).
Conclusion:
A simple risk score integrating MRE-derived liver stiffness and NT-proBNP improved DD identification and prognostication of post-LT MACE, and may serve as a complementary tool in patients equivocal for DD on echocardiography.
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