Key result
A higher postoperative ventriculoarterial coupling ratio was an independent risk factor for major adverse cardiovascular events (OR 6.347) and prolonged hospital stay in liver transplant recipients.
Why the study?
Ventriculoarterial coupling is a key determinant of cardiovascular performance, but little is known about changes in ventriculoarterial coupling after liver transplantation.
Is postoperative ventriculoarterial decoupling associated with adverse cardiovascular outcomes and prolonged hospital stay in liver transplant recipients?
Observational (n=240)
No
Is postoperative ventriculoarterial decoupling associated with adverse cardiovascular outcomes and prolonged hospital stay in liver transplant recipients?
Odds Ratio: 6.347 (95% CI 1.672–24.091)
p-value: p=0.007
Postoperative ventriculoarterial decoupling, assessed via non-invasive echocardiography, is an independent predictor of major adverse cardiovascular events and prolonged hospital stay in liver transplant recipients.
Post-LT ventriculoarterial decoupling flags higher cardiovascular risk; leaves open whether VAC modulation improves outcomes.
BACKGROUND: Liver transplantation (LT) increases the heart and vessel workload in patients with cirrhotic cardiomyopathy. While the interaction of the left ventricle (LV) with the arterial system (ventriculoarterial coupling, VAC) is a key determinant of cardiovascular performance, little is known about changes in VAC after LT. Therefore, we evaluated the relationship between VAC after LT and cardiovascular outcomes. METHODS: 344 consecutive patients underwent echocardiographic assessments before and within 30 days after LT. Non-invasive arterial elastance (Ea), LV end-systolic elastance (Ees), and LV end-diastolic elastance (Eed) were calculated. The postoperative outcomes included the development of major adverse cardiovascular events (MACE) and the length of stay in the intensive care unit and hospital. RESULTS: A total of 240 patients were included in the analyses. After LT, Ea increased by 16% (P < 0.001), and Ees and contractility index of systolic velocity (S') increased by 18% (P < 0.001) and 7% (P < 0.001), respectively. The Eed increased by 6% (P < 0.001). The VAC remained unchanged (0.56 to 0.56, P = 0.912). Of these patients, 29 had MACE, and those with MACE had significantly higher postoperative VAC. Additionally, a higher postoperative VAC was an independent risk factor for a longer postoperative hospital stay (P = 0.038). CONCLUSIONS: These data suggest that ventriculoarterial decoupling is associated with poor postoperative outcomes after LT.
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Kim et al. (2023) conducted an observational in End-stage liver disease undergoing liver transplantation (n=240). Higher postoperative ventriculoarterial coupling (Ea/Ees ratio) vs. Lower postoperative ventriculoarterial coupling was evaluated on Major adverse cardiovascular events (MACE) (OR 6.347, 95% CI 1.672-24.091, p=0.007). A higher postoperative ventriculoarterial coupling ratio was an independent risk factor for major adverse cardiovascular events (OR 6.347) and prolonged hospital stay in liver transplant recipients.
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