Nonalcoholic Steatohepatitis (NASH) is independently associated with increased cardiovascular events after liver transplantation (LT). NASH is also associated with subclinical myocardial dysfunction in the general population. There are limited data on the effects of LT on cardiac function. One recent publication suggests that cardiac function improves post-LT in a non-NASH cohort. We evaluated comprehensive echocardiographic parameters including myocardial strain measured by speckle tracking from 2009-2014 in patients transplanted for NASH cirrhosis before and after LT to assess the effects of LT on myocardial function. Echocardiograms were independently interpreted by an experienced cardiologist. Of 51 patients transplanted for NASH cirrhosis, 36 patients had pre- and post-LT echocardiogram images available for review. The mean time between pre- and post-LT echocardiograms was 669 ± 555 days and 523 ± 517 days from LT to post-LT echocardiograms, respectively. There was no correlation between echocardiographic findings and time between pre and post-LT echo (Spearman r=0.14, p=0.45) or LT to post-LT echo (Spearman r=0.15, p=0.44). Patients were aged 60 ± 10 years, predominantly female (58%), Caucasian (72%)and diabetic (63%). Mean absolute global longitudinal strain (GLS), a marker of subendocardial left ventricular function, worsened after LT (Table). Circumferential, radial and right ventricular (RV) strain were within normal limits, but worsened over time. Ejection fraction was normal both pre- and post-LT. Conclusion: Patients transplanted for NASH cirrhosis have deterioration of subclinical myocardial function over time despite LT. This may account for some of the increased cardiac morbidity seen in patients transplanted for NASH cirrhosis. Prospective studies that assess the association between changes in subclinical myocardial function over time and clinical events in NASH LT recipients are needed.

CITATION INFORMATION: Maddur H, VanWagner L, Gregory D, Wodzinski B, Maganti K, Rinella M. Effects of Liver Transplantation on Cardiac Function in Patients Transplanted for NASH Cirrhosis. Am J Transplant. 2017;17 (suppl 3).

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