Celiker Guler Emel, Omaygenc Mehmet Onur, Naki Deniz Dilan, Yazar Arzu, Karaca Ibrahim Oguz, Korkut Esin
Department of Cardiology, Koc University Hospital, Davutpasa Ave., No:4, Zeytinburnu, 34010 Istanbul, Turkey.
Department of Cardiology, Istanbul Medipol University Hospital, TEM European Highway, Goztepe Exit, No:1, Bagcilar, 34214 Istanbul, Turkey.
J Clin Med. 2023 Mar 15;12(6):2289. doi: 10.3390/jcm12062289.
Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S', or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis.
尽管终末期肝病（ESLD）的血流动力学改变及其与门肺高压的关联已得到充分证实，但ESLD对无门肺高压患者右室收缩功能的长期影响仍被忽视。在此，我们旨在评估ESLD对右室功能的长期影响及其与终末期肝病患者使用非选择性β受体阻滞剂（NSBBs）以及临床、实验室和影像学参数之间的关系。由于担心心脏收缩力降低以及死亡率增加的可能性，NSBBs的使用仍存在争议。纳入了34例肝移植受者。获取了人口统计学特征、实验室检查结果和基线超声心动图测量值。患者在移植后被召回进行经胸超声心动图评估。通过至少有一个值低于右室S'或三尖瓣环平面收缩期位移（TAPSE）的参考水平来确定右室功能障碍。在20.6%的样本人群中观察到孤立的亚临床右室功能障碍。本研究表明，肝硬化中的血流动力学循环以及前负荷和后负荷增加可能对右室功能产生长期影响，即使不存在门肺高压。这些发现强调了移植后肝硬化患者心脏功能随访的重要性。在本研究中，接受普萘洛尔治疗的患者似乎右室功能更好，胃肠道出血更少。我们推测术前普萘洛尔治疗可能通过抑制肾素-血管紧张素系统（RAS）、改善内皮功能以及ESLD中所见的高动力循环来帮助保留右室功能。普萘洛尔的使用与右室功能之间这种潜在的保护关系可能会改善肝硬化患者在肝移植手术期间及肝移植后的死亡率或移植物失败情况。
