Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;6(2):158-162.
doi: 10.5114/ceh.2020.95893. Epub 2020 Jun 1.

Left ventricular diastolic dysfunction in liver transplantation: a stronger association with non-alcoholic steatohepatitis

Hemnishil K Marella  1 , Faisal Kamal  2 , Rahul Peravali  3 , Jake Jacob  4 , Satheesh P Nair  5
Affiliations

Left ventricular diastolic dysfunction in liver transplantation: a stronger association with non-alcoholic steatohepatitis

Hemnishil K Marella et al. Clin Exp Hepatol. 2020 Jun.

Abstract

Aim of the study: Cardiovascular death is an important cause of mortality in end stage liver disease (ESLD) patients undergoing orthotopic liver transplant (OLT). Left ventricular diastolic dysfunction (LVDD) is often the early manifestation and only measurable manifestation of cirrhotic cardiomyopathy. Therefore, it is important to understand the risk factors for LVDD in ESLD patients undergoing OLT and its immediate impact post-operatively.

Material and methods: Electronic medical records (EMR) of 100 consecutive patients who underwent OLT were reviewed at the University of Tennessee/Methodist University Hospital in Memphis, Tennessee, USA. Transthoracic echocardiogram (TTE) reports were accessed to evaluate for LVDD based on the latest 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The clinical and demographic variables were obtained and variable quality measures, incidence of cardiac arrhythmias, and 30-day all-cause mortality were compared.

Results: Patients with LVDD were older (62.7 ±6.3 years vs. 55.9 ±12.3 years, p = 0.017) and were more often female (57% vs. 31%, p = 0.026). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 12%, p = 0.001). In contrast, patients with alcoholic liver disease were less likely to have LVDD (10% vs. 33%, p = 0.032). In a multivariate logistic regression analysis, NASH (OR = 4.4 [95% CI: 1.33-14.5], p = 0.015) and female gender (OR = 3.31 [95% CI: 1.09-9.99], p = 0.033) were independent predictors of LVDD.

Conclusions: In our cohort of patients, the presence of NASH was associated with a higher risk of LVDD. However, presence of LVDD did not influence immediate post-transplant outcome or 30-day all-cause mortality.

Keywords: left ventricular diastolic dysfunction (LVDD); non-alcoholic fatty liver disease (NAFLD); non-alcoholic steatohepatitis (NASH).

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Liu H, Lee SS. Predicting cardiovascular complications after liver transplantation: 007 to the rescue? Liver Transpl 2011; 17: 7-9. - PubMed
    1. Watt KD, Pedersen RA, Kremers WK, et al. . Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant 2010; 10: 1420-1427. - PMC - PubMed
    1. Rahman S, Mallett SV. Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients. World J Hepatol 2015; 7: 507-520. - PMC - PubMed
    1. Izzy M, VanWagner LB, Lin G, et al. . Redefining Cirrhotic Cardiomyopathy for the Modern Era. Hepatology 2020; 71: 334-345. - PMC - PubMed
    1. Liu H, Jayakumar S, Traboulsi M, et al. . Cirrhotic cardiomyopathy: Implications for liver transplantation. Liver Transpl 2017; 23: 826-835. - PubMed