Background
Methods
Study population
Transthoracic echocardiography and ECG
CMR
Statistical analysis
Results
Baseline characteristics
All | Child-Pugh class A/B | Child-Pugh class C | P value | |
---|---|---|---|---|
N = 33 | N = 10 | N = 23 | ||
Age (years) | 56.3 ± 9.9 | 58.8 ± 7.3 | 55.3 ± 10.8 | 0.355 |
Male (n, %) | 25 (75.8%) | 9 (90.0%) | 16 (69.6%) | 0.208 |
Systolic blood pressure (mmHg) | 113.47 ± 14.0 | 111.5 ± 7.6 | 114.4 ± 16.2 | 0.601 |
Diastolic blood pressure (mmHg) | 66.3 ± 12.3 | 60.9 ± 9.0 | 68.8 ± 12.9 | 0.094 |
Heart rate (/min) | 73.6 ± 15.7 | 63.3 ± 9.1 | 78.0 ± 16.0 | 0.002 |
Cirrhosis etiology (n, %) | 0.296 | |||
Viral | 20 (60.6%) | 8 (80.0%) | 12 (52.2%) | |
HBV | 17 (51.5%) | 6 (60.0%) | 11 (47.8%) | |
HCV | 3 (9.1%) | 2 (20.0%) | 1 (4.3%) | |
Alcoholic | 9 (27.3%) | 1 (10.0%) | 8 (34.8%) | |
Autoimmune hepatitis | 2 (6.1%) | 0 (0%) | 2 (8.7%) | |
Cryptogenic | 2 (6.1%) | 1 (10.0%) | 1 (4.3%) | |
Child-Pugh score | 9.8 ± 2.4 | 6.8 ± 1.3 | 11.1 ± 1.2 | < 0.001 |
MELD score | 18.8 ± 7.4 | 11.1 ± 2.1 | 22.1 ± 6.3 | < 0.001 |
Underlying diseases (n, %) | ||||
Hypertension | 8 (24.2%) | 4 (40.0%) | 4 (17.4%) | 0.164 |
Diabetes mellitus | 9 (27.3%) | 4 (40.0%) | 5 (21.7%) | 0.279 |
Medication (n, %) | ||||
Beta-blockers | 8 (24.2%) | 6 (60.0%) | 2 (8.7%) | 0.002 |
Diuretics | 17 (51.5%) | 4 (40.0%) | 13 (56.5%) | 0.383 |
ACEI/ARB | 3 (9.1%) | 2 (20%) | 1 (4.3%) | 0.151 |
Laboratory examination | ||||
Hemoglobin (g/dL) | 10.6 ± 1.6 | 11.4 ± 1.6 | 10.2 ± 1.5 | 0.050 |
Creatinine (mg/dL) | 0.9 ± 0.4 | 0.8 ± 0.2 | 0.9 ± 0.4 | 0.565 |
Bilirubin (mg/dL) | 7.5 ± 8.5 | 1.7 ± 0.6 | 10.0 ± 9.1 | < 0.001 |
Albumin (g/dL) | 2.9 ± 0.4 | 3.2 ± 0.4 | 2.7 ± 0.4 | 0.002 |
PT (INR) | 1.9 ± 1.0 | 1.3 ± 0.2 | 2.1 ± 1.1 | 0.001 |
Echocardiographic and ECG parameters in cirrhosis
Healthy controls | Cirrhosis | Child-Pugh class A/B | Child-Pugh class C | P value† | P value* | |
---|---|---|---|---|---|---|
N = 17 | N = 33 | N = 10 | N = 23 | |||
LVEF (%) | 62.7 ± 5.6 | 66.0 ± 5.2 | 66.4 ± 3.5 | 65.8 ± 5.8 | 0.049 | 0.777 |
LV EDD (mm) | 47.9 ± 4.0 | 48.0 ± 5.5 | 48.6 ± 4.8 | 47.7 ± 5.9 | 0.969 | 0.686 |
LV ESD (mm) | 29.7 ± 4.3 | 28.0 ± 4.3 | 28.2 ± 3.4 | 28.0 ± 4.7 | 0.206 | 0.905 |
LV wall thickness (mm) | 9.1 ± 0.9 | 8.9 ± 1.3 | 9.2 ± 1.3 | 8.8 ± 1.3 | 0.747 | 0.456 |
E/A ratio | 0.9 ± 0.4 | 1.1 ± 0.4 | 1.1 ± 0.4 | 1.2 ± 0.5 | 0.165 | 0.431 |
Deceleration time (msec) | 210.2 ± 30.2 | 212.3 ± 41.0 | 232.3 ± 39.6 | 203.2 ± 39.1 | 0.857 | 0.061 |
E/e’ ratio | 8.6 ± 2.5 | 10.4 ± 2.5 | 10.8 ± 2.4 | 10.2 ± 2.5 | 0.018 | 0.431 |
Diastolic function | 0.474 | 0.776 | ||||
Normal | 9 (52.9%) | 17 (51.5%) | 5 (50.0%) | 12 (52.2%) | ||
Indeterminate | 7 (41.2%) | 15 (45.5%) | 5 (50.0%) | 10 (43.5%) | ||
Grade 1 | 1 (5.9%) | 0 (0%) | ||||
Grade 2 | 0 (0%) | 1 (3.0%) | 0 (0%) | 1 (4.3%) | ||
LA dimension (mm) | 38.2 ± 3.8 | 43.7 ± 7.7 | 47.1 ± 8.9 | 42.2 ± 6.7 | 0.008 | 0.094 |
LAVI (mL/m2) | 39.8 ± 7.8 | 47.3 ± 11.2 | 45.6 ± 12.0 | 48.0 ± 11.0 | 0.020 | 0.565 |
Estimated PASP (mmHg) | 32.1 ± 3.1 | 33.8 ± 5.3 | 31.0 ± 2.9 | 35.1 ± 5.7 | 0.348 | 0.040 |
GLS (%) | −18.6 ± 2.2 | −24.2 ± 2.7 | −25.2 ± 2.7 | −23.8 ± 2.6 | < 0.001 | 0.170 |
GCS (%) | −26.1 ± 4.7 | −27.8 ± 5.1 | −27.7 ± 5.1 | −27.8 ± 5.2 | 0.254 | 0.950 |
Positive agitated saline test (n, %) | 0 (0%) | 22 (66.7%) | 6 (60.0%) | 16 (69.6%) | – | 0.592 |
QTc interval (msec) | 410.5 ± 8.6 | 470.3 ± 36.1 | 453.7 ± 19.9 | 477.6 ± 39.4 | < 0.001 | 0.081 |
CMR in cirrhosis patients
Healthy controls | Cirrhosis | Child-Pugh class A/B | Child-Pugh class C | P value† | P value* | |
---|---|---|---|---|---|---|
N = 20 | N = 33 | N = 10 | N = 23 | |||
LVEF (%) | 63.4 ± 6.4 | 67.8 ± 6.9 | 66.1 ± 6.5 | 68.5 ± 7.1 | 0.027 | 0.368 |
LV EDV (mL) | 135 ± 20 | 150 ± 47 | 153 ± 42 | 149 ± 50 | 0.101 | 0.811 |
LV ESV (mL) | 51 ± 16 | 49 ± 21 | 52 ± 18 | 48 ± 23 | 0.752 | 0.604 |
Stroke volume (mL) | 85 ± 15 | 100 ± 29 | 101 ± 28 | 99 ± 30 | 0.025 | 0.845 |
Cardiac index (L/min) | 3.3 ± 0.7 | 4.3 ± 1.1 | 3.8 ± 1.0 | 4.5 ± 1.1 | 0.002 | 0.073 |
LV mass index (g/m2) | 76.8 ± 13.0 | 70.7 ± 15.8 | 70.1 ± 13.0 | 71.0 ± 17.1 | 0.138 | 0.858 |
LV mass/LV-EDV ratio | 0.9 ± 0.2 | 0.8 ± 0.3 | 0.8 ± 0.3 | 0.9 ± 0.2 | 0.126 | 0.875 |
Presence of LGE | 0 (0%) | 1 (3.0%) | 0 (0%) | 1 (4.3%) | 0.432 | 0.503 |
Native T1 (msec) | 1174 ± 65 | 1228 ± 79 | 1216 ± 60 | 1233 ± 87 | 0.001 | 0.584 |
ECV (%) | 25.4 ± 1.9 | 31.6 ± 5.1 | 27.2 ± 3.4 | 33.6 ± 4.4 | < 0.001 | 0.001 |
Patient | Pre-transplant native T2 | Pre-transplant ECV |
---|---|---|
1 | 35.71 | 24.5% |
2 | 44.41 | 34.6% |
3 | 39.11 | 27.8% |
4 | 44.72 | 32.6% |
5 | 35.71 | 39.8% |
6 | 36.48 | 43.0% |
Changes in echocardiographic and CMR parameters 1 year after transplant
Pre-transplant | 1 year post-transplant | P value | |
---|---|---|---|
Echocardiography | |||
LVEF (%) | 65.8 ± 5.0 | 62.5 ± 4.9 | 0.035 |
LV EDD (mm) | 49.5 ± 4.7 | 46.0 ± 5.1 | 0.003 |
LV ESD (mm) | 28.7 ± 3.9 | 27.9 ± 4.0 | 0.465 |
GLS (%) | −24.9 ± 2.4 | −20.6 ± 3.4 | < 0.001 |
GCS (%) | −28.4 ± 3.6 | −24.6 ± 4.2 | 0.011 |
E/A ratio | 1.18 ± 0.51 | 0.85 ± 0.27 | 0.002 |
E/e’ ratio | 11.0 ± 0.23 | 8.9 ± 2.9 | 0.030 |
CMR | |||
LV EDV (mL)_ | 167 ± 48 | 130 ± 30 | 0.001 |
LV ESV (mL) | 57 ± 22 | 48 ± 17 | 0.102 |
LVEF (%) | 66.8 ± 6.8 | 65.1 ± 6.5 | 0.382 |
LV mass index (g/m2) | 65.2 ± 9.3 | 59.5 ± 8.2 | 0.001 |
LV mass/LV-EDV ratio | 0.7 ± 0.3 | 0.8 ± 0.1 | 0.028 |
Native T1 (msec) | 1206 ± 72 | 1173 ± 73 | 0.121 |
ECV (%) | 30.9 ± 4.5 | 25.4 ± 2.6 | < 0.001 |
Electrocardiogram | |||
QTc interval (msec) | 475 ± 41 | 429 ± 30 | 0.001 |