*Purpose: Cirrhotic cardiomyopathy (CCM) encompasses systolic ± diastolic dysfunction (DD) in patients with end stage liver disease in the absence of known cardiac disease. The echocardiographic criteria for CCM were recently revised to reflect the advancement in echocardiographic technology. This study evaluates the prevalence of CCM, per the new criteria, and its impact on post transplant outcomes.

*Methods: This is a retrospective matched cohort study of liver transplant (LT) recipients between 01/2008 and 11/2017. Three cohorts with decompensated cirrhosis (due to non-alcoholic steatohepatitis, alcoholic liver disease, or other etiologies) were matched based on age (± 5 years), sex, and year of transplant (± 5 years) after excluding patients listed without evidence of hepatic decompensation. Clinical and echocardiographic data were collected. CCM was defined as having diastolic dysfunction, left ventricular ejection fraction <50%, and/or global longitudinal strain>-18%. Major cardiovascular events (MACE) included coronary artery disease (CAD), congestive heart failure (HF), atrial and ventricular dysrhythmia, and stroke. Descriptive analyses were performed.

*Results: 59/141 patients were females. The mean age at LT was 57.8 (±7.6) years. The prevalence of pre LT advanced (i.e. stage 2 or 3) DD was 18.4%. To eliminate non-CCM causes of advanced diastolic dysfunction, prevalence was re-calculated after adjustment for diabetes mellitus, aging, and hypertension and it was 17.7%. DD with indeterminate stage was 14.7%. Ejection fraction was > 50% in all patients reflecting transplant selection criteria. GLS was impaired in 1.7%. The prevalence of CCM was 32.8%. CCM was associated with increased risk of developing MACE after transplant (HR 2.51 (1.13-5.57), p 0.02, figure). There was a trend towards decreased risk for CHF > 3 months after LT in patients with normal diastolic function compared to DD (HR 0.30 (0.08-1.13), p 0.07).

*Conclusions: Cirrhotic cardiomyopathy, defined by abnormal myocardial strain and/or abnormal diastolic function, affects approximately one third of LT candidates. CCM is associated with increased risk for major cardiovascular events following liver transplant. Further studies are needed to validate these findings and evaluate the impact of post LT echocardiographic surveillance.

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