Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Diastolic dysfunction (DD) is the hallmark of cirrhotic cardiomyopathy (CCM) for which criteria were established in 2005. Based on those criteria, the prevalence of CCM was thought to approach 50%. Since then, substantial advancement in the techniques and yield of Echocardiography have occurred. American and European cardiac societies have accordingly set new diastolic dysfunction criteria in 2016. In this study, we evaluate the prevalence of DD among patients with decompensated cirrhosis according to the new criteria.
*Methods: This is a retrospective chart review of patients who underwent liver transplant for decompensated cirrhosis at a large North American center between 01/2008 and 11/2017. Patients with non-alcoholic steatohepatitis (NASH)-related cirrhosis or alcohol-related liver disease (ALD) and complete relevant echocardiographic data were included. Age and Sex-matched controls were patients with decompensated cirrhosis due to other liver diseases. Diastolic dysfunction was defined as 3 or more of the following: annular e’ velocity: septal e’ < 7 cm/sec or lateral e’ <10 cm/sec, average E/e’ ratio > 14, left atrial volume index > 34 mL/m2, and peak tricuspid regurgitation velocity > 2.8 m/sec. E/e’ is ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e’). Descriptive analyses were performed.
*Results: The cohort included 158 patients of whom 59 were women. Mean age at transplant was 58 (±8) years. When the DD criteria from 2005 were applied (i.e., E/A <1 or deceleration time >200 ms), 117/158 patients (74 %) fulfilled the criteria. With the 2016 DD criteria applied, the overall prevalence of DD in the cohort was 12.6% (20/158 patients); 14.5% of patients with NASH-related cirrhosis and 12.7% of patients with ALD compared with 11.1 % of patients with other disease etiologies (p=0.47). 10 of the 20 patients with pre-transplant DD had repeat echocardiography after transplant (median 539 days) and there were no significant changes in the means of diastolic function surrogates after transplant (Table 1).
*Conclusions: Recent advances in echocardiography and the consequential new diastolic dysfunction criteria suggest that CCM may be less common than previously believed. This may explain the relative lack of predictive value of prior CCM criteria on pre and post-transplant outcomes. Post transplant improvement cannot be assumed, thus further evaluation of the outcomes of CCM based on the new DD criteria is needed.
To cite this abstract in AMA style:Izzy MJ, Angirekula M, Leise M, Allen A, Watt K. Redefining Cirrhotic Cardiomyopathy; A Shifting Paradigm [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/redefining-cirrhotic-cardiomyopathy-a-shifting-paradigm/. Accessed May 7, 2021.
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