Purpose: Stress cardiomyopathy is a pathological condition in which excess catecholamines leading to cardiac dysfunction. This phenomenon is associated with troponin elevation, EKG changes, and cardiac dysfunction in a distribution of multiple vascular territories with subsequent recovery. Though best described in the setting of sub-arachnoid hemorrhage, it has been increasingly reported in other situations associated with excess physiological stress. Here we report on our experience of post liver transplant stress cardiomyopathy.

Methods: We retrospectively analyzed all liver transplant recipients from 1/2003 and 3/2015. Patients undergoing cardiac catheterizations or echocardiography post-operative were queried from the Cleveland Clinic transplant database. 8 patients were identified as likely cases of stress cardiomyopathy based on 4 criteria: 1) EKG changes, 2) troponin T elevations, 3) echocardiography suggesting abrupt decrease in cardiac function with subsequent evidence of recovery. 4) no evidence of an ischemic source of cardiac process.

Results:

one case was confirmed stress cardiomyopathy on post operative cardiac catheterization negative for ischemia. 7 cases were likely stress cardiomyopathy as evidenced by fulfilling all 4 criteria but without post operative cardiac catheterization confirming lack of ischemia.

Average pre-operatie Ejection Fraction (EF) on echocardiography was 60±/-3.6%. Post operative EF in setting of cardiomyopathy was 23.8±6.0% and echocardiogram demonstrating recovery showed mean EF of 52.9±7.9%. Mean peak troponin was 0.43±0.50ng/mL.

Conclusions: Stress cardiomyopathy after liver transplant surgery has seldom been reported but is increasingly being recognized as a source of post-operative cardiac dysfunction. The risk factors for development of this physiological phenomenon remain to be elucidated.

CITATION INFORMATION: Presser N, Barzilai B. Stress Cardiomyopathy in the Perio-Perative Period After Liver Transplant. Am J Transplant. 2016;16 (suppl 3).

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