Introduction

Diastolic dysfunction (DD) is the cardinal finding in cirrhotic cardiomyopathy, a condition in patients with liver disease that is associated with an increased risk of cardiovascular events and mortality. We describe the risk factors and impact of left ventricular DD in patients with portal hypertension undergoing liver transplant evaluation.

Methods

We included the first 100 patients enrolled in the Pulmonary Vascular Complications of Liver Disease 2 (PVCLD2) study, a multicenter, prospective cohort study of adult patients with portal hypertension undergoing their first evaluation for liver transplantation. The research evaluation included a history and physical, and contrast enhanced transthoracic echocardiography (TTE). DD was determined using mitral inflow patterns and tissue Doppler imaging and graded by a core echocardiographic lab.

Results

Of 100 subjects, 65 subjects had TTEs interpretable for DD. Based on classic echocardiographic findings, 33 (50.7%) had DD; 8 with mild (12%), 24 with moderate (37%) and 1 with severe DD. Those with DD were older, were more likely to be Hispanic, and had a higher body mass index than patients without DD (all comparisons, p<0.05). More severe liver disease, as assessed by Child-Pugh score, was associated with a greater risk of DD (p=0.03). Those with DD had worse physical functioning with notable difficulty with the performance of vigorous activities (p=0.04 and p=0.02, respectively). Patients with DD had a lower six-minute walk distance compared to others (382 m vs 430 m, p=0.017). Though DD did not correlate with rates of hospitalizations or liver transplantation, the presence of DD was associated with a six-fold increase risk of death (HR 6.05, 1.39 – 26.37, p=0.017) after adjustment for age and severity of liver disease.

Conclusions

In this cohort of patients being evaluated for liver transplantation, the presence of DD is associated with more severe liver disease, poorer functional status and exercise capacity, and an increased pre-transplant risk of death. Larger studies are needed to develop predictive models that may better identify those at risk and explore potential interventions to mitigate that risk.

CITATION INFORMATION: Forde K, McLean R, O'Donnell W, Krok K, Patel M, Lin G, Oh J, Krowka M, Fallon M, Kawut S. Impact of Left Ventricular Diastolic Dysfunction on Patients Being Evaluated for Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress