Abstract 16350: Diastolic Dysfunction Predicts Adverse Cardiovascular Outcomes After Orthotropic Liver Transplant

Introduction: Around, 6,000 patients in the US undergo liver transplantation (LT) annually. Cirrhotic cardiomyopathy related HF is claimed to be the third leading cause of death after LT. The purpose of this study is to assess whether diastolic dysfunction (DD) measured by echocardiogram prior to surgery predicts poor cardiovascular (CV) outcomes after LT. Methods: A cohort study of 148 patients underwent LT at Einstein Medical Center from 2007-2014. Patients with prior cardiomyopathy, hepato-renal or hepato-pulmonary syndrome and patients on renal replacement therapy were excluded. Echocardiographic parameters for DD were measured according to ASE guidelines. Adverse CV outcomes, defined as pulmonary edema, arrhythmias (A fib, VT/VF), CHF, MI and cardiac arrest in the first year following LT were recorded. Patients were divided into 2 groups according to DD severity: normal and mild (grade I) vs. moderate to severe DD (grade II-IV). Standard statistical tests and regression analyses were performed. Result: Of the 148 patients, 70% were men, 56% were Caucasian, 32% African-American and 8% Hispanic. Classical CV risk factors, cardiac medications and cirrhosis severity were not statistically different between DD groups. Table 1 shows the echocardiographic measures of DD and outcomes after 1 year. The prevalence of moderate to severe DD was 12.1%. At 1 year, pulmonary edema was significantly higher in patients with moderate to severe DD compared to mild or no DD (50% vs. 23.8%, p=0.01) with an OR = 3.2 (95%CI, 1.16-8.75) as well as arrhythmias (33.3% vs.10%, p=0.005) with an OR = 4.5 (95%CI 1.4-14). No significant difference was found in mortality. Conclusion: Moderate to severe DD prior to LT predicts adverse CV complications including pulmonary edema and arrhythmias within a year after LT. Patients with moderate to severe DD should be monitored closely to identify these possible complications to implement prompt treatment.