A Clinical‐Imaging Score Reclassifies Indeterminate Diastolic Dysfunction and Predicts Posttransplant Cardiac Events in Cirrhosis

INTRODUCTION: Left ventricular diastolic dysfunction (DD) is a common cardiac abnormality in patients with liver cirrhosis (LC), associated with adverse peri-and posttransplant outcomes. We aimed to develop a simple clinical risk score incorporating magnetic resonance elastography (MRE) and biomarkers to identify DD and improve prediction of post-liver transplantation (LT) major adverse cardiac events (MACE). METHODS: This retrospective study analyzed 114 LC patients who underwent pre-LT MRE and transthoracic echocardiography (TTE) between 2019 and 2025. Patients with structural heart disease or confounding comorbidities were excluded. Clinical, laboratory, and imaging parameters were analyzed. Independent predictors of DD were identified using logistic regression, and a composite DD risk score was developed. Predictive ability for 1-year post-LT MACE was assessed with and without reclassification of indeterminate cases. RESULTS: The prevalence of DD by TTE was 14.0%. Higher NT-proBNP and liver stiffness on MRE were independent predictors of DD. A composite risk score was derived as (NT-proBNP/50) + (4 × MRE stiffness). Using a cutoff ≥61 points, the score achieved 92% specificity. Among patients with indeterminate DD (35.9% of the cohort), 12.2% were classified as DD using the risk score, raising the prevalence to 18.4%. Incorporating the score improved discrimination of 1-year post-LT MACE (p < 0.001). DD classified by TTE plus risk score was independently associated with MACE (odds ratio [OR], 5.77, p = 0.002). CONCLUSION: A simple risk score integrating MRE-derived liver stiffness and NT-proBNP improved DD identification and prognostication of post-LT MACE, and may serve as a complementary tool in patients equivocal for DD on echocardiography.