Left ventricular function after liver transplantation: 12 months follow up

Abstract Purpose The curative therapy of patients with end stage liver disease is liver transplantation (LTx). End stage liver disease leads to cirrhotic cardiomyopathy which is cardiac dysfunction in the absence of heart disease .Based on current literature , patients undergoing liver Tx develop heart failure during the perioperative period with 7% to 21% mortality . In the present study we aimed to assess LV systolic function in patients 12 months after LTx and compare them to the baseline measurements. Methods We included 30 patients (age 53.65±10.8 years, 25% male) with preserved LV EF and normal dobutamin stress echocardiography results, without any signs or symptoms of systolic heart failure . All of the patients had end stage liver disease and underwent LTx 12 months ago. We compared LV systolic function based on conventional echocardiographic measurements, tissue Doppler imaging (TDI) and strain imaging. Results LV ejection fraction (EF) and systolic pulmonary artery pressure did not change significantly at the end of first year after Ltx (p=0.47 and p=0.43 respectively). Regarding TDI analysis, septal (IVS Sa) and lateral peak systolic velocities (L Sa) slightly decreased but it was not significant (0,08 ± 0,013 to 0,08 ± 0,011, p=1,00 for IVS Sa; 0,08 ± 0,019 to 0,08 ± 0,016, p=0.82 for L Sa). Based of deformation analysis we observed that LV global longitudinal strain (LV GLS) was significantly impaired one year after LTx, compared to the measurements before the operation (19,53 ± 3,64 % to 14,48 ± 2,12 %, p< 0.001). Conclusion In the present study we observed that LV systolic function is impaired one year after LT, based on tissue Doppler and strain imaging parameters. None of the patients developed clinical signs or symptoms of systolic heart failure in the follow up period. LTx challenges the cardiovascular system immediately after the operation and also in the following months. Longer-term post operatively, more sedentary life style, increased obesity and immunosupressants may affect LV function. Pre operative detailed analysis of LV function is important to predict cardiovasular events after LTx and to improve graft survival.