While cardiac involvement in the end-stage liver disease (ESLD) is a known condition, the characteristics of cardiac function in cirrhotic cardiomyopathy and their effects on candidates to liver transplant (LT) are still vague. The evaluation of right ventricular failure (RVF) in liver transplant candidates has been revolutionized by advanced cardiac imaging techniques, particularly echocardiography with global longitudinal strain (GLS) analysis. Aim of the present study is to evaluate RV function indexes in ESLD patients candidate to LT and the potential relationship with the liver disease status and cardiovascular major events on early post-LT phase
Forty ESDL adult patients (age 46.8 ± 10 yrs, M/F 33/7) candidate to LT (19 for hepatic failure, 18 for hepatocarcinoma and 3 for other causes) were evaluate. All were submitted to transthoracic echocardiography and coronary CT angiography or coronary angiography.
The Model for End-stage Liver Disease (MELD) score in the study population was 19±6.8. The higher values of the MELD score (i.e. the worst liver function condition) were directly correlated with the lower RV-GLS (0.02). Cardiac function indexes were LV-EF 62.8±4.5%, RV-GLS -22.9±4.5%, LV-GLS -19.5±4.6% and PAPs 31.8±6.6 mmHg. On 21 day follow-up, 4 patients died (2 with acute RV failure, 1 with Tako-Tsubo syndrome). On CT-angiography the value of calcium score was significantly different between the group of fatal events and the rest (0 vs 567±900), revealing that none of the died patient suffered from coronary atheromatic disease.
Our findings identified that specific RV-GLS patterns on echocardiography, indicative of subclinical myocardial dysfunction, were strongly correlated with worst clinical hepatic conditions and reduced survival rates post-transplant. The study highlights the importance of advanced cardiac imaging in identifying liver transplant candidates at higher risk of post-transplant mortality due to RHF.