Improvement of biventricular myocardial function in patients with cirrhosis following liver transplantation

Abstract

BACKGROUND: Patients with cirrhosis have been shown to be associated with myocardial dysfunction. However, limited studies have evaluated cardiac function in patients with cirrhosis before and after liver transplantation. PURPOSE: The aim of the study is to evaluate biventricular myocardial function before and after liver transplantation in patients with cirrhosis. METHODS: A total of 67 consecutive patients (mean age 54.9±7.7 years; 73.1% male) with cirrhosis referred for liver transplantation were recruited. Conventional and advanced 2-dimensional speckle tracking echocardiography were performed to assess for biventricular function. During the follow up period, a total of 41 patients underwent successful liver transplantation and the rest remains on the liver transplantation waiting list. A second echocardiography was performed in all patients within the following date (patients following liver transplantation: 18.2±6.6 months and patients who did not receive liver transplantation: 20.4±8.3 months). RESULTS: For patients who received liver transplantation, a reduction of left ventricular (LV) diastolic and systolic volume (71.3±16.9ml vs. 91.4±27.1ml and 25.2±7.7ml vs. 32.2±12.9ml, respectively; both P<0.01), a trend towards a lower LV mass (195.8±54.5g vs. 214.0±55.1g, P=0.05) and improved LV global longitudinal and circumferential strains (−20.8±2.0% vs. −18.5±2.6% and −18.7±2.3% vs. −16.5±2.4%, respectively; both P<0.01) were observed. In addition, these patients showed a reduction of right ventricular (RV) end diastolic and systolic area (12.4±2.2cm2 vs. 13.6±3.7cm2 and 5.5±1.2cm2 vs. 6.2±2.1cm2, respectively; both P<0.05), and improved RV strain (−23.2±2.5% vs. −21.0±4.8%, P<0.01) following liver transplantation. For patients who did not receive liver transplantation, both left and right heart dimension and function remained similar between first and second echocardiography. CONCLUSION: The present study demonstrates that patients with cirrhosis had reduced biventricular chamber dimension and improved biventricular systolic function following liver transplantation. No such association was found in patients who did not receive liver transplantation. The present finding thus suggested that myocardial dysfunction in patients with cirrhosis could be reversed following successful liver transplantation.