Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
PLoS One. 2019 Jan 25;14(1):e0209100. doi: 10.1371/journal.pone.0209100. eCollection 2019.
Although pretransplant cardiac dysfunction is considered a major predictor of poor outcomes after liver transplantation (LT), the ability of left ventricular (LV) systolic/diastolic function (LVSF/LVDF), together or individually, to predict mortality after LT is poorly characterized. We retrospectively evaluated pretransplant clinical and Doppler echocardiographic data of 839 consecutive LT recipients from 2009 to 2012 aged 18-60 years. The primary endpoint was all-cause mortality at 4 years. The overall survival rate was 91.2%. In multivariate Cox analysis, reduced LV ejection fraction (LVEF, P = 0.014) and decreased transmitral E/A ratio(P = 0.022) remained significant prognosticators. In LVSF analysis, patients with LVEF≤60% (quartile [Q]1) had higher mortality than those with LVEF>60% (hazard ratio = 1.90, 95% confidence interval = 1.15-3.15, P = 0.012). In LVDF analysis, patients with an E/A ratio<0.9(Q1) had a 2.19-fold higher risk of death (95% confidence interval = 1.11-4.32, P = 0.024) than those with an E/A ratio>1.4(Q4). In combined LVDF and LVSF analysis, patients with an E/A ratio<0.9 and LVEF≤60% had poorer survival outcomes than patients with an E/A ratio≥0.9 and LVEF>60% (79.5% versus 93.3%, P = 0.001). Patients with an early mitral inflow velocity/annular velocity (E/e' ratio)>11.5(Q4) and LV stroke volume index (LVSVI)<33mL/m2(Q1) showed worse survival than those with an E/e' ratio≤11.5 and LVSVI ≥33mL/m2(78.4% versus 92.2%, P = 0.003). A combination of LVSF and LVDF is a better predictor of survival than LVSF or LVDF alone.
尽管移植前心功能障碍被认为是肝移植（LT）后不良预后的主要预测因素，但左心室（LV）收缩/舒张功能（LVSF/LVDF）的整体或单独能力预测 LT 后死亡率的能力描述较差。我们回顾性评估了 2009 年至 2012 年间 839 例年龄在 18-60 岁之间的连续 LT 受者的移植前临床和多普勒超声心动图数据。主要终点是 4 年时的全因死亡率。总生存率为 91.2%。多变量 Cox 分析显示，左室射血分数（LVEF）降低（P=0.014）和二尖瓣血流 E/A 比值降低（P=0.022）仍然是显著的预后指标。在 LVSF 分析中，LVEF≤60%（四分位[Q]1）的患者死亡率高于 LVEF>60%（危险比=1.90，95%置信区间=1.15-3.15，P=0.012）。在 LVDF 分析中，E/A 比值<0.9（Q1）的患者死亡风险增加 2.19 倍（95%置信区间=1.11-4.32，P=0.024）比 E/A 比值>1.4（Q4）的患者。在联合 LVDF 和 LVSF 分析中，E/A 比值<0.9 和 LVEF≤60%的患者比 E/A 比值≥0.9 和 LVEF>60%的患者生存率更差（79.5%比 93.3%，P=0.001）。早期二尖瓣流入速度/环速度（E/e'比值）>11.5（Q4）和左室每搏量指数（LVSVI）<33mL/m2（Q1）的患者的生存情况比 E/e'比值≤11.5 和 LVSVI≥33mL/m2（78.4%比 92.2%，P=0.003）的患者更差。LVSF 和 LVDF 的联合应用比单独的 LVSF 或 LVDF 更能预测生存率。
