Bi Shenghua, Jiang Yueping, Zhao Wenjun, Niu Xiaoyan, Liu Xuechun, Jing Xue
Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Surg. 2023 Jan 6;9:1072908. doi: 10.3389/fsurg.2022.1072908. eCollection 2022.
Diastolic dysfunction (DD), one of the earliest signs of cirrhotic cardiomyopathy (CCM), is included in the revised 2019 CCM criteria. Nonetheless, relevant research regarding the effects of revised DD on post-liver transplantation (LT) outcomes remains limited.
This retrospective study enrolled patients who underwent LT for decompensated cirrhosis, from January 2018 to March 2021. Patients were divided into DD and non-DD groups. Clinical data were collected. Patients were followed up with, for at least 1 year post-LT; cardiovascular adverse events (AEs) and survival status were recorded. Risk factors were identified using 1:2 propensity score matching (PSM), after adjusting for confounding factors. The caliper value was set to 0.02.
Of 231 patients, 153 were diagnosed with DD (male, 81.8%; mean age, 51.5 ± 9.5 years). Nineteen patients with DD died within 1 year, post-LT. After PSM, 97 and 60 patients were diagnosed with and without DD, respectively. Patients with DD had longer intensive care unit (ICU) stays, higher perioperative cardiovascular AEs, and higher mortality rates than those without DD. In a multivariate analysis, interventricular septum (IVS), left atrial volume index (LAVI), and potassium levels were independent prognostic factors of perioperative cardiovascular AEs, while a decreased early diastolic mitral annular tissue velocity (e'), increased neutrophil-to-lymphocyte ratio (NLR) and tumor markers were predictors of mortality within 1 year post-LT after PSM ( < 0.05).
Cardiac DD may contribute to perioperative cardiovascular AEs and mortality post-LT. Clinicians should be aware of decompensated cirrhosis in patients with DD.
舒张功能障碍（DD）是肝硬化性心肌病（CCM）最早的表现之一，已被纳入2019年修订的CCM标准。然而，关于修订后的DD对肝移植（LT）术后结局影响的相关研究仍然有限。
本回顾性研究纳入了2018年1月至2021年3月因失代偿期肝硬化接受LT的患者。患者分为DD组和非DD组。收集临床数据。对患者进行LT术后至少1年的随访；记录心血管不良事件（AE）和生存状态。在调整混杂因素后，使用1:2倾向评分匹配（PSM）确定危险因素。卡尺值设定为0.02。
231例患者中，153例被诊断为DD（男性，81.8%；平均年龄，51.5±9.5岁）。19例DD患者在LT术后1年内死亡。PSM后，分别有97例和60例患者被诊断为有和无DD。与无DD的患者相比，DD患者的重症监护病房（ICU）住院时间更长，围手术期心血管AE更高，死亡率更高。在多变量分析中，室间隔（IVS）、左心房容积指数（LAVI）和钾水平是围手术期心血管AE的独立预后因素，而舒张早期二尖瓣环组织速度（e'）降低、中性粒细胞与淋巴细胞比值（NLR）升高和肿瘤标志物是PSM后LT术后1年内死亡的预测因素（<0.05）。
心脏DD可能导致LT围手术期心血管AE和死亡。临床医生应注意DD患者的失代偿期肝硬化。
