title: Left ventricular dyssynchrony in patients with end-stage liver disease.
abstract: BACKGROUND
  Limited published data suggested that patients with end-stage liver disease (ESLD) might have "cirrhotic cardiomyopathy," which could have an earlier stage manifested by mechanical dyssynchrony before left ventricular (LV) dysfunction.
  
  
  RESULTS
  We studied consecutive patients with ESLD who had a stress-gated Tc-99m sestamibi myocardial perfusion imaging between 2008 and 2010 prior to liver transplant. Patients with LVEF < 50%, abnormal perfusion, or QRS ≥ 120 ms were excluded. Baseline demographics, co-morbidities, model for ESLD (MELD) score, LV volumes, mass, ejection fraction (EF), and dyssynchrony indices (standard deviation and bandwidth) were extracted. The phase indices were compared to a normal cohort. There were 179 patients with a mean age 53 ± 8 years, LVEF 72 ± 10%. Hepatitis C, non-alcoholic steatohepatitis, and alcohol abuse were the most common cause of liver cirrhosis (40%, 18%, and 14%, respectively). Patients with ESLD had similar standard deviation (14 ± 8° vs 15 ± 6°, P = NS) and bandwidth (41 ± 25° vs 42 ± 14°, P = NS) to the normal cohort. Only four patients (2%) had a standard deviation >27° (mean + 2 SD of the control group). The phase standard deviations and bandwidth similar in patients with MELD scores of ≤10, 11-18, 19-24, and ≥25 (P = NS for both). There was no correlation between the MELD score and standard deviation or bandwidth (r = -0.044 and -0.068, respectively, P = NS for both). Also, there was no correlation between the QTc and dyssynchrony indices. After 1-year follow-up, 22 patients died (12%). The dyssynchrony indices were similar among those who died and those who survived.
  
  
  CONCLUSIONS
  Patients with ESLD and normal EF have no evidence for LV dyssynchrony.
authors.affiliation: Division of Cardiovascular Medicine, Section of Cardiovascular Imaging, Cleveland Clinic, Mail Code J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA. aljarow@ccf.org
authors.forename: Wael
authors.initials: W
authors.lastname: Aljaroudi
authors.forename: Himanshu
authors.initials: H
authors.lastname: Aggarwal
authors.forename: Fahad
authors.initials: F
authors.lastname: Iqbal
authors.forename: Jaekyeong
authors.initials: J
authors.lastname: Heo
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
mesh_terms: D015897:Comorbidity; D058625:End Stage Liver Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*