Impact and persistence of cirrhotic cardiomyopathy after liver transplantation.
Cirrhotic cardiomyopathy causes variable degree of systolic and diastolic dysfunction (DD) and conduction abnormalities. The primary aim of our study was to determine whether pre-transplant DD and prolonged corrected QT (QTc) predict a composite of mortality, graft failure, and major cardiovascular events after liver transplantation. We also evaluated the reversibility of cirrhotic cardiomyopathy after transplantation. Adult patients who underwent liver transplantation at our institution from January 2007 to March 2009 were included. Data were obtained from institutional registry, medical record review, and evaluation of echocardiographic images. Among 243 patients, 113 (46.5%) had grade 1 DD, 16 (6.6%) had grade 2 DD, and none had grade 3 DD. The mean pre-transplant QTc was 453 milliseconds. After a mean post-transplant follow-up of 5.2 years, 75 (31%) patients satisfied the primary composite outcome. Cox regression analysis did not show any significant association between DD and the composite outcome (P=.17). However, longer QTc was independently associated with the composite outcome (HR: 1.01, 95% confidence interval: 1.00-1.02, P=.05). DD (P<.001) and left ventricular mass index (P=.001) worsened after transplantation. In conclusion, QTc prolongation appears to be associated with worse outcomes. Although DD did not impact outcomes, it significantly worsened after transplantation.
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
Abraham
A
Sonny
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Ahmed
A
Ibrahim
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Andres
A
Schuster
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Wael A
WA
Jaber
Departments of General Anesthesiology, Outcomes Research and Transplantation Center, Cleveland Clinic, Cleveland, OH, USA. cywinsj@ccf.org.
Jacek B
JB
Cywinski
D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002423:Cause of Death / Q000639:trends; D003971:Diastole; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
QTc; cirrhotic cardiomyopathy; diastolic dysfunction; liver transplantation; mortality