Cardiovascular dysfunction and liver transplantation

Kwon, Hye‐Mee; Hwang, Gyu‐Sam

doi:10.4097/kjae.2018.71.2.85

Cited by 44 publications

(51 citation statements)

References 54 publications

(66 reference statements)

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“…(8,9) Because of advances in surgical and anesthetic techniques, the main causes of death after LT at present are associated with early cardiovascular mortality. (7,13) Therefore, it is crucial to identify patients at higher risk of perioperative cardiovascular complications. Currently, all LT candidates undergo routine echocardiographic examinations, as recommended by guidelines of the American Association for the Study of Liver Diseases.…”

Section: Figmentioning

confidence: 99%

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

et al. 2020

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Background and Aims Enhanced sympathetic nervous activation and peripheral vasodilation in end‐stage liver disease (ESLD) may limit the importance of left ventricular ejection fraction (LVEF) as an influential prognosticator. We sought to understand the LVEF and cardiac dimensions in ESLD patients in order to define the LVEF threshold to predict all‐cause mortality after liver transplantation (LT). Approach and Results Data were collected prospectively from the Asan LT Registry between 2008 and 2016, and outcomes were retrospectively reviewed. LVEF, end‐diastolic volume index (EDVI), and end‐diastolic elastance (Eed) were measured by preoperative echocardiography. Of 2,799 patients, 452 (16.2%) had LVEF ≤ 60%, with 29 (1.0%) having LVEF < 55% and 269 (9.6%) had LVEF ≥ 70%. Over a median of 5.4‐year follow‐up, 329 (11.8%) patients died: 104 (3.7%) died within 90 days. LVEF (range, 30%‐81%) was directly proportionate to Model for End‐stage Liver Disease (MELD) scores, an index of liver disease severity, in survivors but showed a fixed flat‐line pattern in nonsurvivors (interaction P = 0.004 between groups), with lower EDVI (P = 0.013) and higher Eed (P = 0.001) in the MELD ≥ 20 group. Patients with LVEF ≤ 60% had higher 90‐day (13% vs. 7.4%; log rank, P = 0.03) and median 5.4‐year (26.7% vs. 16.2%; log rank, P = 0.003) mortality rates in the MELD ≥ 20 group, respectively, compared to those with LVEF > 60%. Specifically, in the MELD > 35 group, median 5.4‐year mortality rate was 53.3% in patients with LVEF ≤ 60% versus 24% in those with LVEF > 60% (log rank P < 0.001). By contrast, mortality rates of LVEF ≤ 60% and > 60% were similar in the MELD < 20 group (log rank P = 0.817). Conclusions LVEF ≤ 60% is strongly associated with higher post‐LT mortality rates in the MELD ≥ 20 group, indicating the need to appraise both LVEF and liver disease severity simultaneously. Enhanced diastolic elastance with low EDVI provides insights into pathogenesis of low LVEF in nonsurvivors with MELD ≥ 20.

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Section: Figmentioning

confidence: 99%

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

et al. 2020

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“…Cirrhotic cardiomyopathy is associated with poor outcomes following LT . Diastolic dysfunction pre‐LT is associated with a 2‐fold increased risk of graft failure and a 1.5‐fold increased risk of all‐cause mortality .…”

Section: Implications Pre‐lt and Post‐ltmentioning

confidence: 99%

“…Of note, coronary artery disease (CAD) is associated with 50% mortality at 1‐3 years following LT . Risk factors for CAD are more prevalent in patients with alcohol‐related and nonalcoholic steatohepatitis cirrhosis, with one third of patients with cirrhosis having nonobstructive CAD (<50% stenosis) .…”

Section: Implications Pre‐lt and Post‐ltmentioning

confidence: 99%

“…Cirrhotic cardiomyopathy is associated with poor outcomes following LT. (26,65) Diastolic dysfunction pre-LT is associated with a 2-fold increased risk of graft failure and a 1.5-fold increased risk of all-cause mortality. (26) Cardiomyopathy is also associated with a 3-fold increased risk of developing heart failure following LT. (65) As the definition of cirrhotic cardiomyopathy is changing, (26) prospective studies using revised criteria for diastolic dysfunction and heart failure with preserved ejection fraction are needed.…”

Section: Cardiac Sarcopeniamentioning

confidence: 99%

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Sarcopenia in Cirrhosis: Looking Beyond the Skeletal Muscle Loss to See the Systemic Disease

2019

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Sarcopenia is a common complication of cirrhosis and is defined as a progressive and generalized loss of skeletal muscle mass, strength, and function. Sarcopenia is associated with poor prognosis and increased mortality. How sarcopenia and muscle wasting relate to such poor outcomes requires looking beyond the overt muscle loss and at this entity as a systemic disease that affects muscles of vital organs including cardiac and respiratory muscles. This review explores the pathophysiological pathways and mechanisms that culminate in poor outcomes associated with sarcopenia. This provides a launching pad to identify potential targets for therapeutic intervention and optimization to improve patient outcomes.

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“…At this stage, other mechanisms, such as activation of the renin-angiotensin system, sympathetic nervous system, and antidiuretic hormone overproduction, are employed to maintain effective circulating blood volume and perfusion pressure. Activation of these same compensatory systems is the leading cause of sodium and water retention and, ultimately, ascites formation [52,53].…”

Section: Role Of the Hyperdynamic Circulationmentioning

confidence: 99%

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Vitin¹,

Tomescu²,

Azamfirei³

2019

Liver Cirrhosis - Debates and Current Challenges

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Nonischemic cardiomyopathy is a collective term, encompassing a spectrum of cardiac comorbidities, accompanying the progressing end-stage liver disease. Alcoholic and cirrhotic cardiomyopathies are the most researched, well-known clinical entities in the list of nonischemic cardiac disorders that bear the most substantial impact on the clinical course, management, and outcomes of liver transplantation in ESLD patients. In this chapter, morphology, pathophysiology, diagnostic criteria, clinical manifestations, and management options of nonischemic cardiomyopathy in liver transplant candidates and recipients, the patients with end-stage liver disease due to advanced stages of cirrhosis, are discussed.

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Cardiovascular dysfunction and liver transplantation

Cited by 44 publications

References 54 publications

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

Sarcopenia in Cirrhosis: Looking Beyond the Skeletal Muscle Loss to See the Systemic Disease

Nonischemic Cardiomyopathy in Liver Transplant Recipients

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