*Purpose: Assess the prevalence and characteristics of patients without arrhythmia or structural heart disease (SHD) but with impaired pre-transplant left ventricular global longitudinal strain (GLS) and its impact on post-transplant morbidity and mortality.

*Methods: Retrospective study of 80 consecutive cirrhotic patients undergoing liver transplantation (LT) from 1/1/2021 to 10/31/2021 at the University of Maryland Medical Center. Data were collected on pre-transplant demographics, cardiovascular risk factors, etiology of liver disease, Model for End-Stage Liver Disease score (MELD-Na), Child Pugh score (CP), and presence of arrhythmias or SHD; and post-transplant hospital and intensive care unit (ICU) stay, readmission rate, new major cardiovascular event (MACE), and mortality rate. Left ventricular GLS was considered impaired if the value was <-18%.

*Results: 68 patients were included (12 patients had underlying arrhythmia or SHD pre-transplantation and were excluded). Mean age at LT was 68 years (range, 24-75) and mean MELD-Na 25.3 (range, 6-40); 44% were women; 58.8%, 23.5%, 11.7%, and 5.8% had alcoholic liver disease, nonalcoholic fatty liver disease, viral hepatitis, or other etiologies, respectively; 17.6% had hepatocellular carcinoma, 13.2%, 17.6%, and 69.1% had CP of A, B, and C, respectively. Hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD), and obesity were present in 60.2%, 27.9%, 25%, and 39.7%, respectively; and 58.8% had smoking history (82.5% of which former smoker).

Patients had a follow up mean time of 173.1 days after transplantation (range, 0-320), 3 patients (4.4%) died, 6 (8.8%) patients developed MACE, and 32 (47%) were readmitted at least once. GLS was available in 18 patients, 5 (27.7%) of which had impaired GLS. Compared to patients with normal GLS, patients with impaired GLS were older (mean age 57.4 years vs. 46 years, p=0.04), had higher mean MELD-NA (35.2 vs. 29.9, p=0.03), and lower mean left ventricular ejection fraction (61% vs. 64%, p<0.05). However, they were not significantly different regarding the presence of HTN, DM, HLD, obesity, or smoking history; or post-transplant readmission, length of hospitalization, ICU stay, MACE, or mortality rates (p≥0.05). Furthermore, patients with impaired GLS had shorter mean survival time in days (86 vs. 156.6 days, p=0.04).

*Conclusions: The prevalence of impaired GLS in cirrhotic patients undergoing LT without arrhythmia or SHD was 27.7%. Although a larger sample size and longer follow-up are required to obtain more conclusive results, our study suggests that patients without arrhythmia or SHD but with impaired GLS may have lower mean post LT survival time.

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