title: Stroke volume response to liver graft reperfusion stress in cirrhotic patients.
abstract: BACKGROUND
  In patients with advanced cirrhosis, stressful stimuli may reveal a silent reduced cardiac performance. During liver transplantation (LT), graft reperfusion strongly stresses the heart and may unmask latent myocardial dysfunction.
  
  
  OBJECTIVE
  The objective of this study was to assess heart response to acutely increased preload after liver graft reperfusion and correlate this response with preoperative data and outcome.
  
  
  METHODS
  Preoperative clinical, echocardiographic, and hemodynamic data, and patient outcome were retrospectively recorded for 235 liver recipients who had no known cardiac disease. Myocardial dysfunction was defined as less than 10 % increase of stroke volume after graft reperfusion (non-responder).
  
  
  RESULTS
  We found 84 (35.7 %) non-responder patients. The non-responders showed higher Model for end-stage liver disease scores (p = 0.046), left atrial diameter (LAD) (p = 0.040), hepatic vein pressure gradient (p = 0.055), and hyperdynamic state than responders. The percentages of patients with hyponatremia (p = 0.048) and alcohol etiology (p = 0.025) were also higher among non-responders. Independent predictors of inadequate cardiac response in the multivariate analysis were low preoperative systemic vascular resistance (SVRI) [odds ratio (OR) 3.09, 95 % CI 1.15-4.82; p = 0.027] and enlargement of LAD (OR 2.08, 95 % CI 1.49-2.74; p = 0.044). Non-response was associated with higher rates of early cardiovascular events [hazard ratio (HR) 2.84, 95 % CI 1.09-4.22; p = 0.039] and higher length of intensive care unit stay (p = 0.038). No differences were found in 1-year survival rates.
  
  
  CONCLUSIONS
  Latent cardiac dysfunction among LT recipients, considered to be abnormal stroke volume response to unclamping of portal vein, is very prevalent. SVRI and LAD were independent predictors of inadequate responses. This condition deserves special attention since it may aggravate the early postoperative course of LT.
authors.affiliation: Department of Anesthesiology, Hospital Clinic, Barcelona, Spain, juiz69@yahoo.com.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Escobar
authors.forename: Pilar
authors.initials: P
authors.lastname: Taurá
authors.forename: Graciela
authors.initials: G
authors.lastname: Martínez-Palli
authors.forename: Constatino
authors.initials: C
authors.lastname: Fondevila
authors.forename: Jaume
authors.initials: J
authors.lastname: Balust
authors.forename: Joan
authors.initials: J
authors.lastname: Beltrán
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagán
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D015424:Reperfusion; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume