Departments of Internal Medicine I.
Internal Medicine II.
Liver Transpl. 2018 Jan;24(1):15-25. doi: 10.1002/lt.24846. Epub 2017 Dec 1.
Late allocation of organs for transplant impairs post-liver transplantation (LT) survival. Cardiac dysfunction, especially diastolic and autonomic dysfunction, is frequent and plays an important role in the prognosis of patients with cirrhosis. However, the role of myocardial contractility is unexplored, and its prognostic value is controversially discussed. This study analyses the role of myocardial contractility assessed by speckle tracking echocardiography in LT allocation. In total, 168 patients with cirrhosis (training cohort, 111; validation cohort [VC], 57) awaiting LT in 2 centers were included in this retrospective study. Also, 51 patients from the training and all patients from the VC were transplanted, 36 patients of the training and 38 of the VC were alive at the end of follow-up, and 21 nontransplanted patients died. Contractility of the left ventricle (LV) increased with severity of the Child-Pugh score. Interestingly, higher LV contractility in the training cohort patients, especially in those with Child-Pugh C, was an independent predictor of reduced transplant-free survival. In male patients, the effects on survival of increased left and right ventricular myocardial contractility were more pronounced. Notably, competing risk analysis demonstrated that increased contractility is associated with earlier LT, which could be confirmed in the VC. Importantly, LV myocardial contractility had no impact on survival of patients not receiving LT or on post-LT survival. In conclusion, this study demonstrates for the first time that increased myocardial contractility in decompensated patients identifies patients who require LT earlier, but without increased post-LT mortality. Liver Transplantation 24 15-25 2018 AASLD.
器官延迟分配会损害肝移植（LT）后的存活率。心脏功能障碍，特别是舒张功能障碍和自主神经功能障碍，在肝硬化患者的预后中较为常见，且起着重要作用。然而，心肌收缩力的作用尚未可知，其预后价值存在争议。本研究分析了斑点追踪超声心动图评估的心肌收缩力在 LT 分配中的作用。本回顾性研究共纳入了 2 个中心的 168 名等待 LT 的肝硬化患者（训练队列 111 例，验证队列 [VC] 57 例）。此外，来自训练队列的 51 名患者和来自 VC 的所有患者均接受了移植，训练队列中有 36 名患者和 VC 中有 38 名患者在随访结束时存活，21 名未移植患者死亡。左心室（LV）的收缩力随 Child-Pugh 评分的严重程度而增加。有趣的是，训练队列患者的 LV 收缩力升高，尤其是 Child-Pugh C 的患者，是移植无生存时间降低的独立预测因素。在男性患者中，左、右心室心肌收缩力增加对生存的影响更为明显。值得注意的是，竞争风险分析表明，收缩力增加与 LT 更早相关，这在 VC 中得到了证实。重要的是，LV 心肌收缩力对未接受 LT 的患者的生存或 LT 后的生存没有影响。总之，本研究首次表明，代偿失调患者的心肌收缩力增加可更早识别需要 LT 的患者，但不会增加 LT 后的死亡率。肝移植 24 15-25 2018 AASLD。
