Ripoll Cristina, Catalina María-Vega, Yotti Raquel, Olmedilla Luis, Pérez-Peña José, Lo Iacono Oreste, Rincón Diego, García-Fernández Miguel Angel, Bermejo Javier, Bañares Rafael
Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Transplantation. 2008 Jun 27;85(12):1766-72. doi: 10.1097/TP.0b013e318172c936.
The aim was to investigate the cardiac response during liver transplantation (LT) and analyze its relationship with clinical factors, echocardiographic, and hemodynamic findings.
All patients undergoing LT for cirrhosis from 1998 to 2004 were included. Clinical data, comprehensive echocardiography, hepatic, and right heart hemodynamic measurements were analyzed. During LT patients underwent continuous right-heart pressure monitorization. Measurements 10 min after reperfusion were compared with baseline values. Abnormal cardiac response was defined as a decrease in left ventricular stroke work index despite a rise in pulmonary wedge capillary pressure. Predictors of abnormal cardiac response were investigated using logistic regression.
Data were available from 209 patients (mean age 52 (9) yrs; Child A 27; B 93; C 89) with a mean model for end-stage liver disease score 16.3 (4.7). Abnormal cardiac response was observed in 47 (22.5%) patients after reperfusion. Patients who developed this response had hyponatremia, lower central venous pressure, lower pulmonary artery pressure, and lower pulmonary wedged capillary pressure. Abnormal cardiac response was related to a longer postoperative intubation time.
Abnormal cardiac response is observed during LT and may be a manifestation of occult cirrhotic cardiomyopathy. This finding is underestimated with usual diagnostic tools and could be related to indirect signs of circulatory dysfunction of advanced liver disease.
目的是研究肝移植（LT）期间的心脏反应，并分析其与临床因素、超声心动图及血流动力学结果的关系。
纳入1998年至2004年期间所有因肝硬化接受肝移植的患者。分析临床数据、综合超声心动图、肝脏及右心血流动力学测量结果。在肝移植期间，患者接受持续的右心压力监测。将再灌注后10分钟的测量值与基线值进行比较。异常心脏反应定义为尽管肺楔压毛细血管压升高，但左心室每搏功指数下降。使用逻辑回归研究异常心脏反应的预测因素。
有209例患者（平均年龄52（9）岁；Child A级27例；B级93例；C级89例）的数据可用，终末期肝病模型评分平均为16.3（4.7）。再灌注后47例（22.5%）患者出现异常心脏反应。出现这种反应的患者有低钠血症、较低的中心静脉压、较低的肺动脉压和较低的肺楔压毛细血管压。异常心脏反应与术后插管时间延长有关。
肝移植期间观察到异常心脏反应，可能是隐匿性肝硬化心肌病的一种表现。这一发现通常的诊断工具会低估，可能与晚期肝病循环功能障碍的间接征象有关。
