Prevalence and outcome of diastolic dysfunction in liver transplantation recipients

Abstract

Objective: Cirrhotic cardiomyopathy (CCMP) denotes a chronic cardiac dysfunction in cirrhotic patients. It is characterized by systolic (SD) and diastolic dysfunction (DD), and electromechanical abnormalities, in the absence of other cardiac diseases. Liver transplantation (LTx) has a favourable effect on CCMP, but CCMP is in itself a risk factor. Aims of the study were (1) to estimate the prevalence of DD among LTx candidates, (2) to compare outcome between patients with and without DD, and (3) to determine if tricuspid regurgitation (TR) is a predictor of post-transplantation outcome.

Methods: 173 LTx recipients were retrospectively evaluated. Diagnostic criteria for SD and DD were a resting ejection fraction < 55% and an E/A ratio < 1 or a deceleration time > 200 msec on echocardiography, respectively, according to the criteria proposed during the World Congress of Gastroenterology in Montreal, 2005. The difference in outcome between patients with and without DD was evaluated in terms of mortality and cardiovascular complications post-transplantation.

Results: SD and DD were diagnosed in 3 (2%) and 74 (43%) patients, respectively. Patients with DD had significantly older age (P < 0.0001). Regarding outcome, no statistically significant difference could be documented. Moderate/severe TR is, in contrast to no or mild TR, associated with worse posttransplantation outcome (P = 0.01 short-term, P = 0.02 long-term).

Conclusion: In this study population, a prevalence of SD and DD of 2% and 43%, respectively, was registered. Outcome does not seem to be strongly affected by the presence of DD. Tricuspid regurgitation severity on echocardiography is predictive of survival.