Abstract 19009: The Association Between Clinical and Echocardiographic Imaging Findings and T2* in End Stage Liver Disease

Abstract

Background: Cirrhosis can lead to cardiac iron deposition (cardiac siderosis), a risk factor for heart failure (CHF) and ventricular arrhythmia. Cardiac magnetic resonance (CMR) T2* analysis is utilized to detect cardiac siderosis prior to liver transplantation (LT). Clinical and TTE correlates with T2* values in patients with end-stage liver disease are not well characterized. Methods and Results: We present a case series of 130 patients with cirrhosis undergoing LT evaluation with T2* and TTE analysis at our institution between 2008-2014. We compared clinical, TTE and functional CMR measures to T2* measures across three categories: <10 (excluded from LT due to high-risk for heart failure or arrhythmia), 10-20 -(cardiac siderosis of indeterminate clinical significance) and ≥20 (normal) using fisher exact test for categorical variables and ANOVA for continuous variables. Clinical characteristics associated with lower values of T2* were: lower body mass index (p=0.01), lower systolic blood pressure (p<0.01). MELD score was higher in those with T2* values between 10-20 (p <0.01). Echocardiographic findings associated with lower T2* values included lower left ventricular (LV), ejection fraction (p<0.01), higher LV end systolic volume index (p <0.01), and higher global longitudinal strain (GLS) in the 4-Chamber, 3-chamber and the overall average GLS (all p < 0.01), though there were fewer participants that had 3-chamber GLS measurements. Conclusions: In this exploratory analysis of LT candidates, lower T2* values correlated with more advanced liver disease including lower BMI, lower systolic blood pressure and MELD score. Intriguingly, higher global longitudinal strain demonstrated a strong correlation with lower T2* in 4 and 3 chambers as well as overall average GLS and may be a valuable tool in the LT evaluation of suspected cardiac iron overload.