The impact of left ventricular hypertrophy on survival in candidates for liver transplantation

Abstract

Left ventricular hypertrophy (LVH) occurs in 12% to 30% of patients with cirrhosis; however, its prognostic significance is not well studied. We assessed the association of LVH with survival in patients undergoing a liver transplantation (LT) evaluation. We performed a multicenter cohort study of patients undergoing an evaluation for LT. LVH was defined with transthoracic echocardiography. The outcome of interest was all-cause mortality. LVH was present in 138 of 485 patients (28%). Patients with LVH were older, more likely to be male and African American, and were more likely to have hypertension. Three hundred forty-five patients did not undergo transplantation (212 declined, and 133 were waiting): 36 of 110 patients with LVH (33%) died, whereas 57 of 235 patients without LVH (24%) died (P = 0.23). After LT, 8 of 28 patients with LVH (29%) died over the course of 3 years, whereas 9 of 112 patients without LVH (8%) died (P = 0.007). This finding was independent of conventional risk factors for LVH, and all deaths for patients with LVH occurred within 9 months of LT. No clinical or demographic characteristics were associated with mortality among LVH patients. In conclusion, the presence of LVH is associated with an early increase in mortality after LT, and this is independent of conventional risk factors for LVH. Further studies are needed to confirm these findings and identify factors associated with mortality after transplantation to improve outcomes.

Figure 1

Selection and outcomes of the study population.

Figure 2

Comparison of the survival of evaluated patients with LVH and evaluated patients without LVH. The survivor functions have been adjusted for race, sex, age, BMI, MELD score, hypertension, and diabetes mellitus. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Figure 3

(A) Comparison of the survival of patients with LVH and patients without LVH censored at the time of LT (patients not listed for LT are included). (B) Comparison of the post-LT survival of patients with LVH and patients without LVH. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]