Preoperative echocardiographic evaluation of cardiac systolic and diastolic function in liver transplant recipients with diabetes mellitus: a propensity-score matched analysis
10.17085/apm.2019.14.4.465
- Author:
Hye Mee KWON
1
;
Youngil JEONG
;
Kyoung Sun KIM
;
Kyeo Woon JUNG
;
Young Jin MOON
;
Gyu Sam HWANG
Author Information
1. Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kshwang@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Diabetes mellitus;
Diastolic heart failure;
Echocardiography;
Liver cirrhosis;
Propensity score;
Systolic heart failure
- MeSH:
Diabetes Mellitus;
Echocardiography;
Heart Failure;
Heart Failure, Diastolic;
Heart Failure, Systolic;
Humans;
Liver Cirrhosis;
Liver Diseases;
Liver;
Mass Screening;
Mortality;
Propensity Score;
Retrospective Studies;
Stroke Volume;
Transplant Recipients;
Transplants
- From:Anesthesia and Pain Medicine
2019;14(4):465-473
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Diabetes mellitus (DM) increases risk of heart failure. It has been shown that diabetes leads to DM-cardiomyopathy, characterized by systolic and diastolic dysfunction. Pre-transplant diastolic dysfunction, has been associated with poor graft outcome and mortality. We assessed the hypothesis that end-stage liver disease (ESLD) patients with diabetes (DM-ESLD), have more advanced cardiac systolic and diastolic dysfunction, compared to ESLD patients without diabetes (Non DM-ESLD).METHODS: We retrospectively evaluated preoperative echocardiography of 1,319 consecutive liver transplant recipients (1,007 Non DM-ESLD vs. 312 DM-ESLD [23.7%]) January 2012–May 2016. Systolic and diastolic indices, such as left ventricular ejection fraction, transmital E/A ratio, tissue doppler s′, e′ velocity, and E/e′ ratio (index of left ventricular end-diastolic pressure), were compared using 1:2 propensity-score matching.RESULTS: DM-ESLD patients showed no differences in systolic indices of left ventricular ejection fraction and s′ velocity, whereas diastolic indices of E/A ratio ≤ 1 (49.0% vs. 40.2% P = 0.014), e′ velocity (median = 7.0 vs. 7.4 cm/s, P < 0.001) and E/e′ ratio (10.9 ± 3.2 vs. 10.1 ± 3.0, P < 0.001), showed worse diastolic function compare with Non DM-ESLD patients, respectively.CONCLUSIONS: DM-ESLD patients suffer higher degree of diastolic dysfunction compared with Non DM-ESLD patients. Based on this, careful preoperative screening for diastolic dysfunction in DM-ESLD patients is encouraged, because poor transplant outcomes have been noted in patients with preoperative diastolic dysfunction.
