Document Detail


Diastolic Dysfunction in Patients With End-Stage Liver Disease is Associated With Development of Heart Failure Early After Liver Transplantation.
MedLine Citation:
PMID:  22918216     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Liver transplantation (LTx) is a life-saving treatment of end-stage liver disease. Cardiac complications including heart failure (HF) are among the leading causes of death after LTx. THE AIM: The aim is to identify clinical and echocardiographic predictors of developing HF after LTx. METHODS: Patients who underwent LTx at the University of Nebraska Medical Center (UNMC) between January 2001 and January 2009 and had echocardiographic study before and within 6 months after transplantation were identified. Patients with coronary artery disease (>70% lesion) were excluded. HF after LTx was defined by clinical signs, symptoms, radiographic evidence of pulmonary congestion, and echocardiographic evidence of left ventricular dysfunction (left ventricle ejection fraction <50%). RESULTS: Among 107 patients (presented as mean age [SD], 55 [10] years; male, 70%) who met the inclusion criteria, 26 (24%) patients developed HF after LTx. The pre-LTx left ventricle ejection fraction did not differ between the HF (69 [7]) and the control groups (69 [7] vs. 67 [6], P=0.30). However, pre-LTx elevation of early mitral inflow velocity/mitral annular velocity (P=0.02), increased left atrial volume index (P=0.05), and lower mean arterial pressure (P=0.03) were predictors of HF after LTx in multivariate analysis. Early mitral inflow velocity/mitral annular velocity greater than 10 and left atrial volume index 40 mL/m2 or more were associated with a 3.4-fold (confidence interval, 1.2-9.4; P=0.017) and 2.9-fold (confidence interval, 1.1-7.5; P=0.03) increase in risk of development of HF after LTx, respectively. CONCLUSIONS: This study suggests that elevated markers of diastolic dysfunction during pre-LTx echocardiographic evaluation are associated with an excess risk of HF and may predict post-LTx survival.
Authors:
Taylor F Dowsley; David B Bayne; Alan N Langnas; Ioana Dumitru; John R Windle; Thomas R Porter; Eugenia Raichlin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-22
Journal Detail:
Title:  Transplantation     Volume:  -     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. 2 Section of Transplantation, Department of Surgery, University of Nebraska Medical Center, Omaha, NE. 3 Address correspondence to: Eugenia Raichlin, M.D., Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 69198-2265.
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