Impact of left ventricular diastolic dysfunction on liver transplantation outcomes based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations

Hemnishil K Marella; Neeraja Yedlapati; Jiten P Kothadia; Vamsee K Mupparaju; Saisindhu Marella; Satheesh P Nair

doi:10.5114/ceh.2021.111001

Impact of left ventricular diastolic dysfunction on liver transplantation outcomes based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations

Clin Exp Hepatol. 2021 Dec;7(4):390-395. doi: 10.5114/ceh.2021.111001. Epub 2021 Nov 26.

Authors

Hemnishil K Marella¹, Neeraja Yedlapati², Jiten P Kothadia¹, Vamsee K Mupparaju³, Saisindhu Marella⁴, Satheesh P Nair¹

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee, USA.
² Division of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
³ Methodist Le Bonheur Healthcare, Memphis, Tennessee, USA.
⁴ University of Louisville, College of Medicine, Louisville, Kentucky, USA.

Abstract

Aim of the study: Cirrhotic cardiomyopathy encompasses systolic dysfunction, left ventricular diastolic dysfunction (LVDD), and conduction abnormalities. This study aims to investigate the impact of LVDD on mortality in patients undergoing liver transplantation (LT).

Material and methods: A retrospective review of 400 consecutive patients who underwent LT at our institution was performed. Patient demographics, clinical data, and transthoracic echocardiogram (TTE) were reviewed to identify LVDD. The total cohort consisted of 266 patients after excluding patients with insufficient TTE data (n = 56), patients with indeterminate LVDD (n = 71), and patients with ejection fraction (EF) < 55% (n = 7). Statistical analysis was performed using descriptive statistics. Cox regressions with hazard ratios (HRs) and 95% confidence intervals (CI) were applied to predict 5-year all-cause mortality. Kaplan-Meier survival analysis was conducted to understand the impact of LVDD on 5-year all-cause mortality.

Results: Patients with LVDD have higher incidence of hyperlipidemia (36% vs. 17%, p = 0.003), hypertension (50% vs. 27%, p = 0.001) and diabetes (52% vs. 30%, p = 0.003). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 24%, p = 0.001). A multivariate logistic regression analysis was performed with age, body mass index (BMI), NASH, alcoholic cirrhosis, hepatitis C, history of diabetes, history of hyperlipidemia, and history of hypertension. In this multivariate logistic regression analysis, NASH (odds ratio [OR] = 4.43 [1.10-17.8], p = 0.04), and history of hypertension (OR = 2.33 [1.16-4.66], p = 0.01) were independent predictors of LVDD. The Kaplan-Meier survival analysis and multivariate Cox regression demonstrated that the presence of LVDD had no impact on 5-year all-cause mortality (log-rank test nonsignificant).

Conclusions: This study indicates that LVDD in end-stage liver disease (ESLD) patients does not affect immediate post-transplant outcomes or 5-year all-cause mortality.

Keywords: cirrhosis; cirrhotic cardiomyopathy; left ventricular diastolic dysfunction; liver transplant; non-alcoholic steatohepatitis.