Author + information
- Vaughn Eyvazian,
- Jonathan Gordin,
- Vatche Agopian,
- Henry Honda,
- Olcay Aksoy,
- Ronald Busuttil and
- Gabriel Vorobiof
Background: Orthotopic liver transplantation (LT) is the only curative treatment for end-stage liver disease, and is a resource-intense, high-risk surgery. While cardiovascular events are the second highest cause of post-LT morbidity, data regarding the development of post-LT cardiomyopathy (CMY) have been scarce. The aim of our study was to determine the incidence and risk factors of post-LT CMY.
Methods: Adult patients undergoing LT from 2005 to 2015 who had preoperative transthoracic echocardiograms (TTE) were included in the analysis. Preoperative clinical characteristics, preoperative and postoperative TTE reports, and survival data were analyzed. CMY was defined as an ejection fraction (EF) < 50%.
Results: Of 1,760 patients included, 601 had a post-LT TTE and 1159 did not. Of those with a TTE, 98 developed a CMY within 180 days of transplant (median 7 days). Patients requiring a postoperative TTE were older (57 v. 55, p < 0.001), had more coronary artery disease (CAD) (10.5% v. 5.8%, p = 0.001) and hypertension (34.2% v. 26.5%, p = 0.002), and more often required preoperative intubation (28.5% v. 16.6%, p < 0.0001), vasopressors (18.9% v. 9.2%, p < 0.0001), and dialysis (45.7% v. 28.9%, p < 0.0001). Their preoperative TTEs more often showed left atrial enlargement (32.7% v. 26.4%, p = 0.0064) and elevated pulmonary systolic pressures (28.9% v. 19.3%, p < 0.0001). Comparing those with a CMY to those with a normal postoperative EF, the CMY cohort more often had a low-normal EF (50-55%) prior to transplant (p = 0.014), wall motion abnormalities (p = 0.01), and a history of coronary artery disease (p = 0.0102). Patients with CMY had significantly worse survival (median survival 2.9 v. 14.1 years), though it was not significantly different than those who had a normal postoperative TTE.
Conclusions: This is the largest study to characterize risk factors in developing CMY in patients undergoing LT. Our findings suggest that patients with abnormal pre-LT EF, wall motion abnormalities, CAD, and critically ill LT recipients are at higher risk to develop postoperative CMY.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Evolving World of LVADs, Transplant and Other Novel Discoveries
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1294-271
- 2017 American College of Cardiology Foundation