Prediction of all-cause mortality after liver transplantation using left ventricular systolic and diastolic function assessment

Although pretransplant cardiac dysfunction is considered a major predictor of poor outcomes after liver transplantation (LT), the ability of left ventricular (LV) systolic/diastolic function (LVSF/LVDF), together or individually, to predict mortality after LT is poorly characterized. We retrospectively evaluated pretransplant clinical and Doppler echocardiographic data of 839 consecutive LT recipients from 2009 to 2012 aged 18–60 years. The primary endpoint was all-cause mortality at 4 years. The overall survival rate was 91.2%. In multivariate Cox analysis, reduced LV ejection fraction (LVEF, P = 0.014) and decreased transmitral E/A ratio(P = 0.022) remained significant prognosticators. In LVSF analysis, patients with LVEF≤60% (quartile [Q]1) had higher mortality than those with LVEF>60% (hazard ratio = 1.90, 95% confidence interval = 1.15–3.15, P = 0.012). In LVDF analysis, patients with an E/A ratioP = 0.024) than those with an E/A ratio>1.4(Q4). In combined LVDF and LVSF analysis, patients with an E/A ratio60% (79.5% versus 93.3%, P = 0.001). Patients with an early mitral inflow velocity/annular velocity (E/e’ ratio)>11.5(Q4) and LV stroke volume index (LVSVI)2(Q1) showed worse survival than those with an E/e’ ratio≤11.5 and LVSVI ≥33mL/m2(78.4% versus 92.2%, P = 0.003). A combination of LVSF and LVDF is a better predictor of survival than LVSF or LVDF alone.

尽管移植前心功能障碍被认为是肝移植（liver transplantation, LT）术后不良预后的主要预测因素，但左心室（left ventricular, LV）收缩/舒张功能（left ventricular systolic function/left ventricular diastolic function, LVSF/LVDF）单独或联合预测肝移植术后死亡率的能力目前尚未得到充分阐明。本研究回顾性分析了2009至2012年间纳入的839例年龄18~60岁的连续肝移植受者的移植前临床资料与多普勒超声心动图数据。本研究的主要终点为术后4年全因死亡率。研究队列的总体生存率为91.2%。多因素Cox回归分析显示，左心室射血分数（left ventricular ejection fraction, LVEF）降低（P=0.014）与二尖瓣口血流E/A比值下降（P=0.022）仍为显著的预后危险因素。在左心室收缩功能分析中，左心室射血分数≤60%（四分位组Q1）的患者死亡率高于左心室射血分数>60%的患者（风险比=1.90，95%置信区间=1.15~3.15，P=0.012）。在左心室舒张功能分析中，E/A比值[原文存在输入疏漏]的患者死亡率高于E/A比值>1.4（Q4）的患者（P=0.024）。在左心室收缩功能与舒张功能联合分析中，E/A比值[原文缺失阈值]且左心室射血分数≤60%的患者生存率为79.5%，显著低于左心室射血分数>60%患者的93.3%（P=0.001）。二尖瓣早期流入速度/瓣环速度（E/e’比值）>11.5（Q4）且左心室每搏输出量指数（left ventricular stroke volume index, LVSVI）处于Q1组的患者，其生存率低于E/e’比值≤11.5且LVSVI≥33mL/m²的患者（78.4% vs 92.2%，P=0.003）。相较于单独应用左心室收缩功能或左心室舒张功能，联合检测左心室收缩功能与舒张功能可更好地预测肝移植受者的术后生存率。