Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 69198-2265, USA.
Transplantation. 2012 Sep 27;94(6):646-51. doi: 10.1097/TP.0b013e31825f0f97.
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 is to identify clinical and echocardiographic predictors of developing HF after LTx.
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%).
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.
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.
肝移植（LTx）是治疗终末期肝病的一种救生治疗方法。心脏并发症，包括心力衰竭（HF），是 LTx 后死亡的主要原因之一。
目的是确定 LTx 后发生 HF 的临床和超声心动图预测因素。
在 2001 年 1 月至 2009 年 1 月期间，在内布拉斯加大学医学中心（UNMC）接受 LTx 的患者，并在移植前和移植后 6 个月内进行了超声心动图检查。排除有冠状动脉疾病（> 70%病变）的患者。LTx 后 HF 的定义为临床体征、症状、放射性肺充血证据和超声心动图左心室功能障碍（左心室射血分数<50%）证据。
在符合纳入标准的 107 名患者（平均年龄[标准差]，55[10]岁；男性，70%）中，26 名（24%）患者发生了 LTx 后 HF。HF（69[7]）和对照组（69[7]与 67[6]，P=0.30）的 LTx 前左心室射血分数无差异。然而，在多变量分析中，LTx 前早期二尖瓣血流速度/二尖瓣环速度升高（P=0.02）、左心房容积指数增加（P=0.05）和平均动脉压降低（P=0.03）是 LTx 后 HF 的预测因素。早期二尖瓣血流速度/二尖瓣环速度大于 10 和左心房容积指数 40ml/m2 或更高与 HF 后发生 HF 的风险增加 3.4 倍（95%置信区间，1.2-9.4；P=0.017）和 2.9 倍（95%置信区间，1.1-7.5；P=0.03）相关。
本研究表明，LTx 前超声心动图评估中舒张功能障碍标志物升高与 HF 风险增加相关，并可能预测 LTx 后生存率。
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