title: Cardiac dysfunction during liver transplantation: incidence and preoperative predictors.
abstract: BACKGROUND
  The aim was to investigate the cardiac response during liver transplantation (LT) and analyze its relationship with clinical factors, echocardiographic, and hemodynamic findings.
  
  
  METHODS
  All patients undergoing LT for cirrhosis from 1998 to 2004 were included. Clinical data, comprehensive echocardiography, hepatic, and right heart hemodynamic measurements were analyzed. During LT patients underwent continuous right-heart pressure monitorization. Measurements 10 min after reperfusion were compared with baseline values. Abnormal cardiac response was defined as a decrease in left ventricular stroke work index despite a rise in pulmonary wedge capillary pressure. Predictors of abnormal cardiac response were investigated using logistic regression.
  
  
  RESULTS
  Data were available from 209 patients (mean age 52 (9) yrs; Child A 27; B 93; C 89) with a mean model for end-stage liver disease score 16.3 (4.7). Abnormal cardiac response was observed in 47 (22.5%) patients after reperfusion. Patients who developed this response had hyponatremia, lower central venous pressure, lower pulmonary artery pressure, and lower pulmonary wedged capillary pressure. Abnormal cardiac response was related to a longer postoperative intubation time.
  
  
  CONCLUSIONS
  Abnormal cardiac response is observed during LT and may be a manifestation of occult cirrhotic cardiomyopathy. This finding is underestimated with usual diagnostic tools and could be related to indirect signs of circulatory dysfunction of advanced liver disease.
authors.affiliation: Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
authors.forename: María-Vega
authors.initials: MV
authors.lastname: Catalina
authors.forename: Raquel
authors.initials: R
authors.lastname: Yotti
authors.forename: Luis
authors.initials: L
authors.lastname: Olmedilla
authors.forename: José
authors.initials: J
authors.lastname: Pérez-Peña
authors.forename: Oreste
authors.initials: O
authors.lastname: Lo Iacono
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: García-Fernández
authors.forename: Javier
authors.initials: J
authors.lastname: Bermejo
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000000981:diagnostic imaging / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology