Key result
Longer pre-transplant QTc was independently associated with a composite of mortality, graft failure, and major cardiovascular events after liver transplantation (HR 1.01; 95% CI 1.00-1.02; P=0.05).
Why the study?
Do pre-transplant diastolic dysfunction and prolonged QTc predict a composite of mortality, graft failure, and major cardiovascular events in adult patients undergoing liver transplantation?
Cohort (n=243)
No
Do pre-transplant diastolic dysfunction and prolonged QTc predict a composite of mortality, graft failure, and major cardiovascular events in adult patients undergoing liver transplantation?
Effect estimate: HR 1.01 (95% CI 1.00-1.02)
p-value: p=0.05
Pre-transplant QTc prolongation is associated with worse clinical outcomes after liver transplantation, while diastolic dysfunction worsens post-transplant.
Longer pre-transplant QTc may identify higher-risk liver transplant candidates; leaves open whether QTc-targeted strategies improve post-transplant outcomes.
Cirrhotic cardiomyopathy causes variable degree of systolic and diastolic dysfunction (DD) and conduction abnormalities. The primary aim of our study was to determine whether pre-transplant DD and prolonged corrected QT (QTc) predict a composite of mortality, graft failure, and major cardiovascular events after liver transplantation. We also evaluated the reversibility of cirrhotic cardiomyopathy after transplantation. Adult patients who underwent liver transplantation at our institution from January 2007 to March 2009 were included. Data were obtained from institutional registry, medical record review, and evaluation of echocardiographic images. Among 243 patients, 113 (46.5%) had grade 1 DD, 16 (6.6%) had grade 2 DD, and none had grade 3 DD. The mean pre-transplant QTc was 453 milliseconds. After a mean post-transplant follow-up of 5.2 years, 75 (31%) patients satisfied the primary composite outcome. Cox regression analysis did not show any significant association between DD and the composite outcome (P=.17). However, longer QTc was independently associated with the composite outcome (HR: 1.01, 95% confidence interval: 1.00-1.02, P=.05). DD (P<.001) and left ventricular mass index (P=.001) worsened after transplantation. In conclusion, QTc prolongation appears to be associated with worse outcomes. Although DD did not impact outcomes, it significantly worsened after transplantation.
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Sonny et al. (2016) conducted a cohort in Cirrhotic cardiomyopathy (n=243). Pre-transplant diastolic dysfunction and prolonged QTc was evaluated on Composite of mortality, graft failure, and major cardiovascular events (HR 1.01, 95% CI 1.00-1.02, p=0.05). Longer pre-transplant QTc was independently associated with a composite of mortality, graft failure, and major cardiovascular events after liver transplantation (HR 1.01; 95% CI 1.00-1.02; P=0.05).
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