Abstract 15985: Liver Transplantation Does Not Reverse Cirrhotic Cardiomyopathy

Abstract

Background: Cirrhotic cardiomyopathy (CCM), a frequent finding in patients with end stage liver disease (ESLD), presents with diastolic dysfunction (DD), hyperdynamic state, and prolonged corrected QT interval (QTc). Liver transplantation (LT) is thought to be the only treatment for CCM. The aim of our study is to assess the reversibility of CCM after LT. Methods: We retrospectively assessed the data of 82 patients collected from the Cleveland Clinic LT database between the years 2007 to 2008 that had an echocardiogram (TTE) and an EKG pre and post-LT. The clinical characteristics were obtained from the electronic record and all EKG and TTE were analyzed by 2 independent observers in the standard manner. The frequency of CCM criteria in ESLD patients was compared with 74 matched controls with no history of liver disease. Results: The median age of patients was 57 years (IQR 19 to 72), 72% were males and 85% were Caucasian. The median time between LT and post-LT testing was 4 years (IQR 0.1 to 6). Compared to controls, patients with ESLD had a longer QTc (449 ±25 vs. 430 ±23 msec; p<0.001) and higher cardiac output (CO) (5.9 ±1.8 vs. 4.8 ±1.1 L/min; p=0.001), left atrial (LA) volume index (33 ±10 vs. 25 ±7 ml/m 2 ; p<0.001), left ventricular (LV) end diastolic volume index (60±14 vs. 49±12 ml/m 2 ; p=0.001 and mitral valve inflow velocity (E) (85 ±23 vs. 75 ±20 cm/sec; p=0.003). Post-LT, there was significant increase in LV mass index (LVMI) (107±38 vs 91±24 gm/ m 2 ; p=0.002) and prevalence of DD (75% vs. 47%; p<0.001) but no difference in CO, LA and LV volumes. In contrast, there was a significant reduction of QTc (449 ±25 to 440 ±28 msec; p=0.04). Conclusions: In our study, patients with ESLD had a higher QTc and CO than matched controls. Post-LT, only QTc showed a significant improvement.