Abstract
To evaluate the ventricular function of patients with biliary atresia (BA) before and after liver transplantation using two-dimensional speckle tracking. Observational, analytical study with healthy control group, volunteers. We recruited patients from 0 to 18 years old who were candidates for liver transplantation and patients after six months of liver transplantation performed for BA from January 1997 to August 2015 at Children’s Institute of São Paulo University Medical School. The patients were submitted to a complete conventional echocardiographic study. After that, the images were captured for global longitudinal strain (GLS). A blood sample was collected for brain natriuretic peptide (BNP) level. Ejection fraction obtained by Simpson’s method was significantly higher in the hepatic pre-transplantation group (p < 0.001), as well as left atrial size (p < 0.001) and left ventricle size (p = 0.039). The left ventricular mass index was significantly higher in pre-transplantation group (p < 0.001). The left atrium volume (p = 0.008) and the left ventricular mass index (p t = 0.035) were higher in the post-transplant group. It was observed that the lower the BNP, the lower/more negative the GLS in the post-transplant group (p = 0.038 and r = 0.427). Significant reduction in the overall longitudinal strain of the left ventricle was detected before (p = 0.01) and after liver transplantation (p = 0.019). A subclinical left ventricular systolic dysfunction was evidenced by two-dimensional speckle tracking technique before and after liver transplantation, even when compared to normal values of the last pediatric meta-analysis.
Highlights
To evaluate the ventricular function of patients with biliary atresia (BA) before and after liver transplantation using two-dimensional speckle tracking
This is an observational, analytical, cross-sectional study with a control group, which included patients from zero to eighteen years old who were candidates for liver transplantation due to BA with severe cirrhosis, patients from zero to eighteen years admitted to liver transplantation due to BA from 1989 to 2015 at Children’s Institute of University of São Paulo Medical School and healthy volunteers controls of primary care units paired by sex and age
The selected children were divided into four groups, each one with 30 participants: patients who were candidates for liver transplantation, healthy controls in the pre-transplant group, patients post-liver transplantation who had any of the following altered parameters on hepatic pre-transplant echocardiography: dilated cardiac chambers, ventricular hypertrophy, systolic dysfunction, diastolic alteration; and healthy controls in the post-transplant group
Summary
To evaluate the ventricular function of patients with biliary atresia (BA) before and after liver transplantation using two-dimensional speckle tracking. The left atrium volume (p = 0.008) and the left ventricular mass index (p t = 0.035) were higher in the post-transplant group. Abbreviations CHD Congenital heart diseases BA Biliary atresia LT Liver transplant CVD Cardiovascular disease US Ultrasound Tx Transplant BNP Brain natriuretic peptide EF Ejection fraction 2D Two dimensions PELD Pediatric end-stage liver disease TAPSE Tricuspid annular plane systolic RVDD Right ventricle diastolic diameter RWT Relative wall thickness LVSD Left ventricular systolic diameter LVDD Left ventricular diastolic diameter. The diagnostic criteria for children are not well established or validated
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