Abstract 20341: Determinants of Abnormal Cardiac Mechanics in Liver Transplant Candidates With Hepatic Steatosis
Background: Patients with cirrhosis can develop myocardial abnormalities, ranging from subclinical LV dysfunction to overt cirrhotic cardiomyopathy, which may impact liver transplantation (LTx) outcomes. We studied the prevalence of, and clinical factors associated with, abnormal cardiac mechanics in patients listed for 2 leading indications for LTx, alcohol-induced (EtOH) and nonalcoholic steatohepatitis (NASH) cirrhosis.
Methods: 90 consecutive LTx candidates underwent comprehensive echo and speckle-tracking analysis for determination of cardiac mechanics (global longitudinal systolic strain [GLS] and early diastolic strain rate [EDSR]). We used multivariable linear regression to evaluate associations between clinical factors, including etiology of liver disease, and cardiac mechanics.
Results: The mean±SD age was 62±8y, 32% were female, and etiology of liver disease was NASH (39%) or EtOH (61%). All patients had normal LVEF (>50%), but absolute GLS was abnormal (<18.9%) in 47% of patients. In both groups, GLS correlated with EDSR (Figure A). However, patients with EtOH cirrhosis had worse EDSR compared to NASH (p=0.003; Figure B); there was no difference in GLS among groups (p=NS). Lower LVEF and family history of CAD were associated with worse GLS. Besides EtOH cirrhosis, diabetes was also associated with lower (worse) EDSR. After adjusting for age, sex, hypertension, diabetes, BMI, and LVEF, EtOH cirrhosis was associated with a 0.44 (95% CI 0.15-0.74) s-1 lower EDSR (p=0.004), and family history of CAD was associated with a 2.7 (0.3-5.1) %-unit lower GLS (p=0.028).
Conclusions: In patients with EtOH or NASH cirrhosis referred for LTx, subclinical LV systolic dysfunction is common, despite a normal LVEF. Systolic and diastolic cardiac mechanics are correlated, even when in the abnormal range, and EtOH cirrhosis is independently associated with worse diastolic mechanics whereas family history of CAD is associated with worse systolic mechanics.
Author Disclosures: C. Medina: None. L. VanWagner: None. V. Daruwalla: None. L. Kia: None. D. Boyd: None. J. Friedman: None. E. Unger: None. S.J. Shah: None. M. Rinella: None.
- © 2014 by American Heart Association, Inc.