Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation

Christian Jansen, Alexander Cox, Robert Schueler, Matthias Schneider, Jennifer Lehmann, Michael Praktiknjo, Alessandra Pohlmann, Johannes Chang, Steffen Manekeller, Georg Nickenig, Gabriela Berlakovich, Christian P Strassburg, Christoph Hammerstingl, Katharina Staufer, Jonel Trebicka

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Resumé

Late allocation of organs for transplant impairs post-liver transplantation (LT) survival. Cardiac dysfunction, especially diastolic and autonomic dysfunction, is frequent and plays an important role in the prognosis of patients with cirrhosis. However, the role of myocardial contractility is unexplored, and its prognostic value is controversially discussed. This study analyses the role of myocardial contractility assessed by speckle tracking echocardiography in LT allocation. In total, 168 patients with cirrhosis (training cohort, 111; validation cohort [VC], 57) awaiting LT in 2 centers were included in this retrospective study. Also, 51 patients from the training and all patients from the VC were transplanted, 36 patients of the training and 38 of the VC were alive at the end of follow-up, and 21 nontransplanted patients died. Contractility of the left ventricle (LV) increased with severity of the Child-Pugh score. Interestingly, higher LV contractility in the training cohort patients, especially in those with Child-Pugh C, was an independent predictor of reduced transplant-free survival. In male patients, the effects on survival of increased left and right ventricular myocardial contractility were more pronounced. Notably, competing risk analysis demonstrated that increased contractility is associated with earlier LT, which could be confirmed in the VC. Importantly, LV myocardial contractility had no impact on survival of patients not receiving LT or on post-LT survival. In conclusion, this study demonstrates for the first time that increased myocardial contractility in decompensated patients identifies patients who require LT earlier, but without increased post-LT mortality. Liver Transplantation 24 15-25 2018 AASLD.

OriginalsprogEngelsk
TidsskriftLiver Transplantation
Vol/bind24
Udgave nummer1
Sider (fra-til)15-25
ISSN1527-6465
DOI
StatusUdgivet - 1. jan. 2018

Fingeraftryk

Liver Transplantation
Heart Ventricles
Echocardiography
Retrospective Studies

Citer dette

Jansen, Christian ; Cox, Alexander ; Schueler, Robert ; Schneider, Matthias ; Lehmann, Jennifer ; Praktiknjo, Michael ; Pohlmann, Alessandra ; Chang, Johannes ; Manekeller, Steffen ; Nickenig, Georg ; Berlakovich, Gabriela ; Strassburg, Christian P ; Hammerstingl, Christoph ; Staufer, Katharina ; Trebicka, Jonel. / Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation. I: Liver Transplantation. 2018 ; Bind 24, Nr. 1. s. 15-25.
@article{9611dce4a23b415986073a1da48b98f9,
title = "Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation",
abstract = "Late allocation of organs for transplant impairs post-liver transplantation (LT) survival. Cardiac dysfunction, especially diastolic and autonomic dysfunction, is frequent and plays an important role in the prognosis of patients with cirrhosis. However, the role of myocardial contractility is unexplored, and its prognostic value is controversially discussed. This study analyses the role of myocardial contractility assessed by speckle tracking echocardiography in LT allocation. In total, 168 patients with cirrhosis (training cohort, 111; validation cohort [VC], 57) awaiting LT in 2 centers were included in this retrospective study. Also, 51 patients from the training and all patients from the VC were transplanted, 36 patients of the training and 38 of the VC were alive at the end of follow-up, and 21 nontransplanted patients died. Contractility of the left ventricle (LV) increased with severity of the Child-Pugh score. Interestingly, higher LV contractility in the training cohort patients, especially in those with Child-Pugh C, was an independent predictor of reduced transplant-free survival. In male patients, the effects on survival of increased left and right ventricular myocardial contractility were more pronounced. Notably, competing risk analysis demonstrated that increased contractility is associated with earlier LT, which could be confirmed in the VC. Importantly, LV myocardial contractility had no impact on survival of patients not receiving LT or on post-LT survival. In conclusion, this study demonstrates for the first time that increased myocardial contractility in decompensated patients identifies patients who require LT earlier, but without increased post-LT mortality. Liver Transplantation 24 15-25 2018 AASLD.",
author = "Christian Jansen and Alexander Cox and Robert Schueler and Matthias Schneider and Jennifer Lehmann and Michael Praktiknjo and Alessandra Pohlmann and Johannes Chang and Steffen Manekeller and Georg Nickenig and Gabriela Berlakovich and Strassburg, {Christian P} and Christoph Hammerstingl and Katharina Staufer and Jonel Trebicka",
note = "{\circledC} 2017 by the American Association for the Study of Liver Diseases.",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/lt.24846",
language = "English",
volume = "24",
pages = "15--25",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "JohnWiley & Sons, Inc.",
number = "1",

}

Jansen, C, Cox, A, Schueler, R, Schneider, M, Lehmann, J, Praktiknjo, M, Pohlmann, A, Chang, J, Manekeller, S, Nickenig, G, Berlakovich, G, Strassburg, CP, Hammerstingl, C, Staufer, K & Trebicka, J 2018, 'Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation', Liver Transplantation, bind 24, nr. 1, s. 15-25. https://doi.org/10.1002/lt.24846

Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation. / Jansen, Christian; Cox, Alexander; Schueler, Robert; Schneider, Matthias; Lehmann, Jennifer; Praktiknjo, Michael; Pohlmann, Alessandra; Chang, Johannes; Manekeller, Steffen; Nickenig, Georg; Berlakovich, Gabriela; Strassburg, Christian P; Hammerstingl, Christoph; Staufer, Katharina; Trebicka, Jonel.

I: Liver Transplantation, Bind 24, Nr. 1, 01.01.2018, s. 15-25.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation

AU - Jansen, Christian

AU - Cox, Alexander

AU - Schueler, Robert

AU - Schneider, Matthias

AU - Lehmann, Jennifer

AU - Praktiknjo, Michael

AU - Pohlmann, Alessandra

AU - Chang, Johannes

AU - Manekeller, Steffen

AU - Nickenig, Georg

AU - Berlakovich, Gabriela

AU - Strassburg, Christian P

AU - Hammerstingl, Christoph

AU - Staufer, Katharina

AU - Trebicka, Jonel

N1 - © 2017 by the American Association for the Study of Liver Diseases.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Late allocation of organs for transplant impairs post-liver transplantation (LT) survival. Cardiac dysfunction, especially diastolic and autonomic dysfunction, is frequent and plays an important role in the prognosis of patients with cirrhosis. However, the role of myocardial contractility is unexplored, and its prognostic value is controversially discussed. This study analyses the role of myocardial contractility assessed by speckle tracking echocardiography in LT allocation. In total, 168 patients with cirrhosis (training cohort, 111; validation cohort [VC], 57) awaiting LT in 2 centers were included in this retrospective study. Also, 51 patients from the training and all patients from the VC were transplanted, 36 patients of the training and 38 of the VC were alive at the end of follow-up, and 21 nontransplanted patients died. Contractility of the left ventricle (LV) increased with severity of the Child-Pugh score. Interestingly, higher LV contractility in the training cohort patients, especially in those with Child-Pugh C, was an independent predictor of reduced transplant-free survival. In male patients, the effects on survival of increased left and right ventricular myocardial contractility were more pronounced. Notably, competing risk analysis demonstrated that increased contractility is associated with earlier LT, which could be confirmed in the VC. Importantly, LV myocardial contractility had no impact on survival of patients not receiving LT or on post-LT survival. In conclusion, this study demonstrates for the first time that increased myocardial contractility in decompensated patients identifies patients who require LT earlier, but without increased post-LT mortality. Liver Transplantation 24 15-25 2018 AASLD.

AB - Late allocation of organs for transplant impairs post-liver transplantation (LT) survival. Cardiac dysfunction, especially diastolic and autonomic dysfunction, is frequent and plays an important role in the prognosis of patients with cirrhosis. However, the role of myocardial contractility is unexplored, and its prognostic value is controversially discussed. This study analyses the role of myocardial contractility assessed by speckle tracking echocardiography in LT allocation. In total, 168 patients with cirrhosis (training cohort, 111; validation cohort [VC], 57) awaiting LT in 2 centers were included in this retrospective study. Also, 51 patients from the training and all patients from the VC were transplanted, 36 patients of the training and 38 of the VC were alive at the end of follow-up, and 21 nontransplanted patients died. Contractility of the left ventricle (LV) increased with severity of the Child-Pugh score. Interestingly, higher LV contractility in the training cohort patients, especially in those with Child-Pugh C, was an independent predictor of reduced transplant-free survival. In male patients, the effects on survival of increased left and right ventricular myocardial contractility were more pronounced. Notably, competing risk analysis demonstrated that increased contractility is associated with earlier LT, which could be confirmed in the VC. Importantly, LV myocardial contractility had no impact on survival of patients not receiving LT or on post-LT survival. In conclusion, this study demonstrates for the first time that increased myocardial contractility in decompensated patients identifies patients who require LT earlier, but without increased post-LT mortality. Liver Transplantation 24 15-25 2018 AASLD.

U2 - 10.1002/lt.24846

DO - 10.1002/lt.24846

M3 - Journal article

C2 - 28834154

VL - 24

SP - 15

EP - 25

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 1

ER -