Key result
Preoperative left ventricular diastolic dysfunction, defined by the 2016 ASE criteria, was not associated with long-term mortality after liver transplant.
Why the study?
The impact of left ventricular diastolic dysfunction on survival after liver transplant was not known, especially when defined using current diagnostic criteria.
Does the presence of left ventricular diastolic dysfunction per the 2016 ASE criteria increase all-cause mortality after liver transplant in patients with end-stage liver disease?
Systematic Review (n=4,793)
Does the presence of left ventricular diastolic dysfunction per the 2016 ASE criteria increase all-cause mortality after liver transplant in patients with end-stage liver disease?
Preoperative left ventricular diastolic dysfunction defined by the 2016 ASE criteria was not significantly associated with increased long-term mortality after liver transplant, though evidence is limited by high heterogeneity and few studies.
Answers are grounded in this paper and cite their sources.
LVDD per 2016 ASE criteria shows no post-LT mortality difference; leaves open need for prospective validation of refined diastolic criteria in transplant risk models.
Left Ventricular Diastolic Dysfunction is a hallmark of cirrhotic cardiomyopathy and has been linked to worse quality of life and outcomes in patients with end-stage liver disease. Its impact on survival after liver transplant is not known, especially using current diagnostic criteria to define LVDD. We performed a systematic review and metanalysis of current published literature on mortality after liver transplant in patients with left ventricular diastolic dysfunction. We searched for articles in PubMed, Scopus, EMBASE, Web of Science, and the COCHRANE Central database. We selected articles with adequate inclusion and exclusion criteria. Our primary outcome of interest was all cause mortality after liver transplant in relation to the presence of left ventricular diastolic dysfunction per the 2016 American Society of Echocardiography criteria. A total of 1029 articles were screened during the selection process. Two studies included in the metanalysis showed no significant difference on mortality, but heterogeneity was high. A narrative review of other studies that classified diastolic function with different criteria was also performed, finding association to worse outcomes in these patients. High quality prospective studies using current criteria are needed to corroborate these findings.
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Martínez et al. (2023) conducted a systematic review in End-stage liver disease (ESLD) (n=4,793). Left ventricular diastolic dysfunction (LVDD) per 2016 ASE criteria vs. Without left ventricular diastolic dysfunction was evaluated on All-cause mortality after liver transplant (OR 0.13, 95% CI -0.20-0.47). Preoperative left ventricular diastolic dysfunction, defined by the 2016 ASE criteria, was not associated with long-term mortality after liver transplant.
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