Effect of ventriculo-arterial coupling on transplant outcomes in cirrhotics: Analysis of pressure-volume curve relations

详细信息    查看全文

• 作者：Won-Jung Shin¹ ; Jun-Gol Song¹ ; In-Gu Jun¹ ; Young-Jin Moon¹ ; Hye-Mee Kwon¹ ; Kyeowoon Jung¹ ; Seon-Ok Kim² ; Gyu-Sam Hwang¹ ; ^{kshwang@amc.seoul.kr}
• 关键词：Cirrhotic cardiomyopathy ; Liver transplantation ; Pressure-volume relationship ; Ventricular elastance
• 刊名：Journal of Hepatology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：66
• 期：2
• 页码：328-337
• 全文大小：1175 K
• 卷排序：66

文摘

Ventriculo-arterial coupling (VAC) reflects the interaction between ventricular performance and effective arterial load. Current criteria for cirrhotic cardiomyopathy focus only on cardiac function without addressing the effect of hyperdynamic, low-resistance circulation. We investigated alterations in VAC in cirrhotic patients and their associations with post-liver transplant all-cause mortality.MethodsIn this single institution cohort study, cirrhotic patients who underwent liver transplantation (LT) (n = 914) were retrospectively compared with healthy matched controls using noninvasively measured end-systolic ventricular elastance (Ees), arterial elastance (Ea), and VAC (Ea/Ees). All-cause mortality based on VAC values were investigated using a Cox hazard model with the inverse probability treatment weighting (IPTW) of propensity score.ResultsCirrhotic patients had significantly lower Ees, Ea and VAC values than controls. Over a median of 30 months, 96 patients died after LT. In patients with a high model for end-stage liver disease score (⩾25), VAC of >0.61 (highest tertile) had poorer survival outcomes than patients with VAC of ⩽0.50 (lowest tertile) (66.0% vs. 91.8%; Log-rank p = 0.001), and was independently associated with risk of mortality (hazard ratio, 2.44; 95% CI, 1.10–5.39; p = 0.028) compared with VAC of ⩽0.61 after IPTW adjustment.ConclusionsIn cirrhotic patients, ventricular elastance and VAC values are lower than those in controls. However, in advanced cirrhotic patients, an increase in VAC value is associated with all-cause mortality after LT, suggesting that this non-invasive estimation of ventriculo-arterial uncoupling is an additional novel prognosticator in cirrhotic cardiovascular disorders.Lay summaryIn cirrhotic patients, cardiac dysfunction is latent and only manifests under stressful conditions because of arterial vasodilation. In this study, based on the pressure-volume curve of cardiac function, we investigated characteristics of the ventricular-arterial coupling in cirrhotic patients and further found that disparities in the ventriculo-arterial relationship are associated with graft failure and all-cause mortality after liver transplantation.