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Echocardiographic assessment of cardiovascular function and clinical outcomes in liver transplant recipients
Background & Aims Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardia...
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| Published in: | Clinical transplantation 2022-11, Vol.36 (11), p.e14793-n/a |
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| container_title | Clinical transplantation |
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| creator | Lim, Wen Hui Chew, Nicholas WS Quek, Jingxuan Ng, Cheng Han Tan, Darren Jun Hao Xiao, Jieling Nah, Benjamin Lee, Guan Huei Huang, Daniel Q. Tan, Eunice Xiang Xuan Muthiah, Mark D. |
| description | Background & Aims
Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardiac function and structure in LT recipients and identify independent predictors of prognosis using echocardiography.
Methods
From 2009 to 2019, 178 adult LT recipients at a tertiary academic transplant center were retrospectively studied. Transthoracic echocardiograms 1‐year pre‐ and post‐LT were assessed. Primary outcomes were progression of systolic and diastolic function. Secondary outcomes included left ventricular remodeling, all‐cause mortality, and heart failure readmission post‐LT. Subgroup analyzes were performed for etiology of native liver disease. A multivariable model was constructed to examine independent predictors of outcomes.
Results
Systolic function significantly worsened, with reduction in stroke volume (45–37 ml/m2, p |
| doi_str_mv | 10.1111/ctr.14793 |
| format | article |
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Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardiac function and structure in LT recipients and identify independent predictors of prognosis using echocardiography.
Methods
From 2009 to 2019, 178 adult LT recipients at a tertiary academic transplant center were retrospectively studied. Transthoracic echocardiograms 1‐year pre‐ and post‐LT were assessed. Primary outcomes were progression of systolic and diastolic function. Secondary outcomes included left ventricular remodeling, all‐cause mortality, and heart failure readmission post‐LT. Subgroup analyzes were performed for etiology of native liver disease. A multivariable model was constructed to examine independent predictors of outcomes.
Results
Systolic function significantly worsened, with reduction in stroke volume (45–37 ml/m2, p < .001), left ventricular ejection fraction (LVEF) (65%–62%, p < .001) and cardiac index (3.00–2.60 L/min/m2, p < .001). Conversely, there were significant improvements in diastolic indices, including tricuspid regurgitation Vmax (228–215 cm/s, p = .017), left atrial volume index (LAVI) (32–26 ml/m2, p < .001) and right ventricular systolic pressure (RVSP) (31–28 mmHg, p = .001). Additionally, patients had increased relative wall thickness (RWT) (p < .001) and decreased left ventricular end‐diastolic dimension/body surface area (p < .001) post‐LT. The independent predictors for all‐cause mortality and heart failure were increased pre‐LT mitral annular early diastolic velocity (HR 1.11, CI 1.02–1.22, p = .018), LAVI (HR 1.06, CI 1.02–1.11, p = .007) and decreased LVEF (HR .89, CI .82–.97, p = .006). The effect of non‐alcoholic steatohepatitis on cardiovascular outcomes post‐LT was largely comparable to that of Hepatitis B.
Conclusion
This study showed reduced systolic and improved diastolic function in LT recipients and highlighted the utility of pre‐LT echocardiogram in the prognostication and risk stratification of LT candidates.]]></description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/ctr.14793</identifier><identifier>PMID: 35962725</identifier><language>eng</language><publisher>Denmark</publisher><subject>Adult ; diagnostic imaging ; Echocardiography ; Heart Failure ; Humans ; liver transplantation ; Liver Transplantation - adverse effects ; myocardial contraction ; Retrospective Studies ; Stroke Volume ; Ventricular Function, Left ; ventricular remodeling</subject><ispartof>Clinical transplantation, 2022-11, Vol.36 (11), p.e14793-n/a</ispartof><rights>2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3253-2bd2d0f2f977880022c8bf4636be176bd42d304aecf88afc2c2fa91f5d0d5d53</citedby><cites>FETCH-LOGICAL-c3253-2bd2d0f2f977880022c8bf4636be176bd42d304aecf88afc2c2fa91f5d0d5d53</cites><orcidid>0000-0002-9724-4743 ; 0000-0001-6446-7871</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35962725$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lim, Wen Hui</creatorcontrib><creatorcontrib>Chew, Nicholas WS</creatorcontrib><creatorcontrib>Quek, Jingxuan</creatorcontrib><creatorcontrib>Ng, Cheng Han</creatorcontrib><creatorcontrib>Tan, Darren Jun Hao</creatorcontrib><creatorcontrib>Xiao, Jieling</creatorcontrib><creatorcontrib>Nah, Benjamin</creatorcontrib><creatorcontrib>Lee, Guan Huei</creatorcontrib><creatorcontrib>Huang, Daniel Q.</creatorcontrib><creatorcontrib>Tan, Eunice Xiang Xuan</creatorcontrib><creatorcontrib>Muthiah, Mark D.</creatorcontrib><title>Echocardiographic assessment of cardiovascular function and clinical outcomes in liver transplant recipients</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description><![CDATA[Background & Aims
Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardiac function and structure in LT recipients and identify independent predictors of prognosis using echocardiography.
Methods
From 2009 to 2019, 178 adult LT recipients at a tertiary academic transplant center were retrospectively studied. Transthoracic echocardiograms 1‐year pre‐ and post‐LT were assessed. Primary outcomes were progression of systolic and diastolic function. Secondary outcomes included left ventricular remodeling, all‐cause mortality, and heart failure readmission post‐LT. Subgroup analyzes were performed for etiology of native liver disease. A multivariable model was constructed to examine independent predictors of outcomes.
Results
Systolic function significantly worsened, with reduction in stroke volume (45–37 ml/m2, p < .001), left ventricular ejection fraction (LVEF) (65%–62%, p < .001) and cardiac index (3.00–2.60 L/min/m2, p < .001). Conversely, there were significant improvements in diastolic indices, including tricuspid regurgitation Vmax (228–215 cm/s, p = .017), left atrial volume index (LAVI) (32–26 ml/m2, p < .001) and right ventricular systolic pressure (RVSP) (31–28 mmHg, p = .001). Additionally, patients had increased relative wall thickness (RWT) (p < .001) and decreased left ventricular end‐diastolic dimension/body surface area (p < .001) post‐LT. The independent predictors for all‐cause mortality and heart failure were increased pre‐LT mitral annular early diastolic velocity (HR 1.11, CI 1.02–1.22, p = .018), LAVI (HR 1.06, CI 1.02–1.11, p = .007) and decreased LVEF (HR .89, CI .82–.97, p = .006). The effect of non‐alcoholic steatohepatitis on cardiovascular outcomes post‐LT was largely comparable to that of Hepatitis B.
Conclusion
This study showed reduced systolic and improved diastolic function in LT recipients and highlighted the utility of pre‐LT echocardiogram in the prognostication and risk stratification of LT candidates.]]></description><subject>Adult</subject><subject>diagnostic imaging</subject><subject>Echocardiography</subject><subject>Heart Failure</subject><subject>Humans</subject><subject>liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>myocardial contraction</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><subject>Ventricular Function, Left</subject><subject>ventricular remodeling</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp1kEtLAzEQx4Motj4OfgHJUQ-teewrRym-oCBI70t2kmgku1mT3Uq_vdGt3pzLDDM_fgx_hC4oWdJUNzCEJc1KwQ_QnHIhFoRQdojmRBCW5oLP0EmM72lb0CI_RjOei4KVLJ8jdwdvHmRQ1r8G2b9ZwDJGHWOruwF7g6fbVkYYnQzYjB0M1ndYdgqDs50F6bAfB_Ctjth22NmtDngIsou9k0kSNNjeJl08Q0dGuqjP9_0Ube7vNqvHxfr54Wl1u14AZzlfsEYxRQwzoiyrihDGoGpMVvCi0bQsGpUxxUkmNZiqkgYYMCMFNbkiKlc5P0VXk7YP_mPUcahbG0G79I32Y6xZSRgtS0FEQq8nFIKPMWhT98G2MuxqSurvbOuUbf2TbWIv99qxabX6I3_DTMDNBHxap3f_m-rV5mVSfgG554Zi</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Lim, Wen Hui</creator><creator>Chew, Nicholas WS</creator><creator>Quek, Jingxuan</creator><creator>Ng, Cheng Han</creator><creator>Tan, Darren Jun Hao</creator><creator>Xiao, Jieling</creator><creator>Nah, Benjamin</creator><creator>Lee, Guan Huei</creator><creator>Huang, Daniel Q.</creator><creator>Tan, Eunice Xiang Xuan</creator><creator>Muthiah, Mark D.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9724-4743</orcidid><orcidid>https://orcid.org/0000-0001-6446-7871</orcidid></search><sort><creationdate>202211</creationdate><title>Echocardiographic assessment of cardiovascular function and clinical outcomes in liver transplant recipients</title><author>Lim, Wen Hui ; Chew, Nicholas WS ; Quek, Jingxuan ; Ng, Cheng Han ; Tan, Darren Jun Hao ; Xiao, Jieling ; Nah, Benjamin ; Lee, Guan Huei ; Huang, Daniel Q. ; Tan, Eunice Xiang Xuan ; Muthiah, Mark D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3253-2bd2d0f2f977880022c8bf4636be176bd42d304aecf88afc2c2fa91f5d0d5d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>diagnostic imaging</topic><topic>Echocardiography</topic><topic>Heart Failure</topic><topic>Humans</topic><topic>liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>myocardial contraction</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><topic>Ventricular Function, Left</topic><topic>ventricular remodeling</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lim, Wen Hui</creatorcontrib><creatorcontrib>Chew, Nicholas WS</creatorcontrib><creatorcontrib>Quek, Jingxuan</creatorcontrib><creatorcontrib>Ng, Cheng Han</creatorcontrib><creatorcontrib>Tan, Darren Jun Hao</creatorcontrib><creatorcontrib>Xiao, Jieling</creatorcontrib><creatorcontrib>Nah, Benjamin</creatorcontrib><creatorcontrib>Lee, Guan Huei</creatorcontrib><creatorcontrib>Huang, Daniel Q.</creatorcontrib><creatorcontrib>Tan, Eunice Xiang Xuan</creatorcontrib><creatorcontrib>Muthiah, Mark D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lim, Wen Hui</au><au>Chew, Nicholas WS</au><au>Quek, Jingxuan</au><au>Ng, Cheng Han</au><au>Tan, Darren Jun Hao</au><au>Xiao, Jieling</au><au>Nah, Benjamin</au><au>Lee, Guan Huei</au><au>Huang, Daniel Q.</au><au>Tan, Eunice Xiang Xuan</au><au>Muthiah, Mark D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Echocardiographic assessment of cardiovascular function and clinical outcomes in liver transplant recipients</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2022-11</date><risdate>2022</risdate><volume>36</volume><issue>11</issue><spage>e14793</spage><epage>n/a</epage><pages>e14793-n/a</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract><![CDATA[Background & Aims
Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardiac function and structure in LT recipients and identify independent predictors of prognosis using echocardiography.
Methods
From 2009 to 2019, 178 adult LT recipients at a tertiary academic transplant center were retrospectively studied. Transthoracic echocardiograms 1‐year pre‐ and post‐LT were assessed. Primary outcomes were progression of systolic and diastolic function. Secondary outcomes included left ventricular remodeling, all‐cause mortality, and heart failure readmission post‐LT. Subgroup analyzes were performed for etiology of native liver disease. A multivariable model was constructed to examine independent predictors of outcomes.
Results
Systolic function significantly worsened, with reduction in stroke volume (45–37 ml/m2, p < .001), left ventricular ejection fraction (LVEF) (65%–62%, p < .001) and cardiac index (3.00–2.60 L/min/m2, p < .001). Conversely, there were significant improvements in diastolic indices, including tricuspid regurgitation Vmax (228–215 cm/s, p = .017), left atrial volume index (LAVI) (32–26 ml/m2, p < .001) and right ventricular systolic pressure (RVSP) (31–28 mmHg, p = .001). Additionally, patients had increased relative wall thickness (RWT) (p < .001) and decreased left ventricular end‐diastolic dimension/body surface area (p < .001) post‐LT. The independent predictors for all‐cause mortality and heart failure were increased pre‐LT mitral annular early diastolic velocity (HR 1.11, CI 1.02–1.22, p = .018), LAVI (HR 1.06, CI 1.02–1.11, p = .007) and decreased LVEF (HR .89, CI .82–.97, p = .006). The effect of non‐alcoholic steatohepatitis on cardiovascular outcomes post‐LT was largely comparable to that of Hepatitis B.
Conclusion
This study showed reduced systolic and improved diastolic function in LT recipients and highlighted the utility of pre‐LT echocardiogram in the prognostication and risk stratification of LT candidates.]]></abstract><cop>Denmark</cop><pmid>35962725</pmid><doi>10.1111/ctr.14793</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9724-4743</orcidid><orcidid>https://orcid.org/0000-0001-6446-7871</orcidid></addata></record> |
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| source | Wiley |
| subjects | Adult diagnostic imaging Echocardiography Heart Failure Humans liver transplantation Liver Transplantation - adverse effects myocardial contraction Retrospective Studies Stroke Volume Ventricular Function, Left ventricular remodeling |
| title | Echocardiographic assessment of cardiovascular function and clinical outcomes in liver transplant recipients |
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