Addoumieh Antoine, Abdallah Mouin S, Ballout Jad A, Thuita Lucy, Klein Allan, Jaber Wael A, Arsanjani Reza, Carey William, Majdalany David
Heart and Vascular Institute, Cleveland Clinic Foundation, USA.
Quantitative Health Science Department, Cleveland Clinic Foundation, USA.
Am Heart J Plus. 2021 Jun 24;4:100026. doi: 10.1016/j.ahjo.2021.100026. eCollection 2021 Apr.
Patients with end stage liver disease (ESLD) have a hyperdynamic state due to decreased systemic vascular resistance and increased cardiac output. Preoperative evaluation with dobutamine stress echocardiography (DSE) is used to risk-stratify patients prior to liver transplant. We sought to identify the impact of inducible left ventricular outflow tract obstruction (LVOTO) on DSE on post-operative liver transplant outcomes.
Patients with ESLD who underwent liver transplant at Cleveland Clinic between January 2007 and August 2016 were identified. Pre-operative DSE data, and post-operative intensive care unit (ICU) data were extracted. Patients with inducible LVOTO were compared to those without LVOTO.
Of the 515 patients identified who underwent DSE prior to liver transplant, 165 (30%) were female, and 95 (18%) had LVOTO. There were no major differences in baseline characteristics between the two groups. In the LVOTO group, rest gradients were 10.8 ± 3 mm Hg while peak gradients were 90 ± 48.2 mm Hg. No significant differences in ICU length of stay or duration of mechanical ventilation between both groups were noted. There were 21 deaths at 30 days. There were 2 (2.1%) deaths in the LVOTO group, versus 19 (4.5%) deaths in the non LVOTO group (p = 0.28). Higher Model for End Stage Liver Disease (MELD) scores predicted longer duration of mechanical ventilation and ICU length of stay.
Inducible LVOTO on DSE does not adversely affect the short-term outcomes post liver transplant. Presence of inducible LVOTO should not be the mere reason to deny liver transplant among patients with ESLD.
终末期肝病（ESLD）患者由于体循环血管阻力降低和心输出量增加而处于高动力状态。多巴酚丁胺负荷超声心动图（DSE）术前评估用于肝移植前对患者进行风险分层。我们试图确定DSE诱导的左心室流出道梗阻（LVOTO）对肝移植术后结果的影响。
确定2007年1月至2016年8月在克利夫兰诊所接受肝移植的ESLD患者。提取术前DSE数据和术后重症监护病房（ICU）数据。将诱导性LVOTO患者与无LVOTO患者进行比较。
在确定的515例肝移植前接受DSE的患者中，165例（30%）为女性，95例（18%）有LVOTO。两组间基线特征无重大差异。在LVOTO组中，静息压差为10.8±3mmHg，而峰值压差为90±48.2mmHg。两组间ICU住院时间或机械通气时间无显著差异。30天时有21例死亡。LVOTO组有2例（2.1%）死亡，而非LVOTO组有19例（4.5%）死亡（p = 0.28）。较高的终末期肝病模型（MELD）评分预示机械通气时间和ICU住院时间更长。
DSE诱导的LVOTO不会对肝移植术后短期结果产生不利影响。诱导性LVOTO的存在不应成为拒绝ESLD患者肝移植的唯一理由。
