S1137 The Impact of Electrocardiogram Parameters on Cardiovascular Complications at Time of Liver Transplantation

Abstract

Introduction: Electrocardiogram (ECG) is an integral component of cardiovascular assessment in patients evaluated for liver transplant (LT). However, despite its centrality, there is paucity of data linking ECG interval and rhythm assessment to peri-LT cardiovascular events. Methods: In this retrospective study, the ECG of all patients receiving LT at our institution between 2010-2018 (n=651) were reviewed independently by two cardiologists blinded to clinical data according to the Minnesota classification. Primary outcome included cardiac arrest, new-onset cardiac arrythmia or known arrhythmia requiring change in medication that occurred within 4 weeks of LT. Results: The mean age was 56±10 years and consisted mainly of males (n=478) and Whites (n=469). Leading etiology of cirrhosis was hepatitis C (n=276), followed by NASH (n=120) and alcohol-related liver disease (n=104). At LT evaluation, 633 patients were in sinus rhythm, while atrial fibrillation or flutter was present in 18 subjects. The most common abnormal ECG findings included prolonged QTc (n=347), left ventricular hypertrophy (n=58), right bundle branch block (n=28), and left bundle branch block (n=6). Patients with NASH were more likely to have atrial fibrillation/flutter (5.8% vs. 2.1%; p=0.03), interventricular conduction delay (13.3% vs. 5.1%; p=0.003), and left anterior fascicular block (5.8% vs. 1.3%; p=0.007). The likelihood of primary outcome was 17.3% with the most common arrhythmia being atrial fibrillation (n=53, 8.1%), followed by bradycardia (n=22, 3.4%), supraventricular tachycardia (n=10, 1.5%), and sinus tachycardia (n=9, 1.4%). Primary outcome was more common among patients with dyslipidemia (24.3% vs. 15.5%, p=0.01) and CAD (23.6% vs. 15.0%, p=0.008). After adjusting for gender, BMI, beta blocker use, diabetes, dyslipidemia, statin use, and presence of CAD, age (HR 1.06, p=0.001) and male gender (HR 1.97, p=0.04) were associated with increased risk of post-LT arrythmias. While aspirin (HR 0.37, P=0.02) and prolonged QRS (HR 0.49, p=0.04) were associated with lower risk of cardiovascular events. Conclusion: ECG abnormalities are common among patients with cirrhosis, particularly NASH cirrhosis. It is likely perturbation the bio-clinical profile (older, diabetic, obese, electrolyte abnormalities) that predispose them to developing peri-transplant arrhythmias. Well designed mechanistic studies are required to better understand the pathophysiology to implement targeted peri-transplant therapy to mitigate this risk.