Hepatology Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, South Australia, Australia.
College of Medicine and Public Health, Flinders University, South Australia, Australia.
Clin Transplant. 2022 Jul;36(7):e14682. doi: 10.1111/ctr.14682. Epub 2022 May 16.
The prognostic role of cardiac dysfunction in cirrhotic patients is increasingly recognized. We studied its impact on morbidity and mortality before and after liver transplantation (LT) including development of post-transplant cardiovascular disease (CVD). In this retrospective study, cirrhotic patients who underwent LT assessment from January 2010 to December 2020 were reviewed. Demographics, cardiac investigations and clinical courses were analyzed to identify the prevalence of cardiac dysfunction and its role in LT outcomes. Survival analysis was performed using Cox proportional hazard regression modelling, with LT as a time-varying covariate and as an interaction variable with cardiac dysfunction. Three hundred and eight patients (70% male) were studied. The median (interquartile range) age at LT assessment was 56 (12) years. Cardiac dysfunction was found in 178 (58%) patients (diastolic, 169; systolic, 26; both, 17) and was significantly associated with hepatorenal syndrome/acute kidney injury and peri- and post-transplant morbidity (adjusted odds ratio [aOR] 1.94, 95% CI 1.06-3.52, P < .001; aOR 2.01, 95% CI 1.06-3.82, P = .033; aOR 1.9, 95% CI 1.01-3.65, P = .023, respectively). Cardiac dysfunction was not associated with mortality before (adjusted hazard ratio [aHR] 1.01, 95% CI .99-1.01) or after LT (aHR .74, 95% CI .4-1.05. Post-transplant CVD (61% cardiac failure) occurred in 36 patients, and there was no significant association with cardiac dysfunction (P = .11). Cardiac dysfunction was common in LT candidates and was significantly associated with morbidity before and after LT. Studies on the role of advanced echocardiographic parameters to improve diagnosis of cardiac dysfunction and optimize LT outcomes are needed.
心脏功能障碍在肝硬化患者中的预后作用日益受到重视。我们研究了它在肝移植（LT）前后对发病率和死亡率的影响，包括移植后心血管疾病（CVD）的发展。在这项回顾性研究中，我们回顾了 2010 年 1 月至 2020 年 12 月接受 LT 评估的肝硬化患者。分析了人口统计学、心脏检查和临床过程，以确定心脏功能障碍的患病率及其在 LT 结果中的作用。使用 Cox 比例风险回归模型进行生存分析，将 LT 作为时变协变量，并作为与心脏功能障碍的交互变量。研究了 308 名患者（70%为男性）。LT 评估时的中位（四分位距）年龄为 56（12）岁。发现 178 名（58%）患者存在心脏功能障碍（舒张期 169 例；收缩期 26 例；两者均为 17 例），且与肝肾综合征/急性肾损伤和围手术期及术后发病率显著相关（调整后优势比 [aOR] 1.94，95%CI 1.06-3.52，P<.001；aOR 2.01，95%CI 1.06-3.82，P=.033；aOR 1.9，95%CI 1.01-3.65，P=.023）。心脏功能障碍与 LT 前（调整后危险比[aHR]1.01，95%CI 0.99-1.01）或 LT 后死亡率无关（aHR.74，95%CI.4-1.05）。36 例患者发生移植后 CVD（61%为心力衰竭），但与心脏功能障碍无显著相关性（P=.11）。LT 候选者中常见心脏功能障碍，与 LT 前后发病率显著相关。需要研究先进的超声心动图参数在诊断心脏功能障碍和优化 LT 结果中的作用。
