| Objective To investigate the prevalence,clinical characteristics and the prognosis of cardiovascular complications in liver transplant recipients.The main contents of this study include the following three parts: 1.hemodynamic characteristics and cardiac alterations of patients with advanced liver disease;2.prevalence,clinical characteristics and prognosis of portopulmonary hypertension(Po PH)in liver transplant recipients;3.prevalence,clinical characteristics and prognosis of cirrhotic cardiomyopathy(CCM)in liver transplant recipients with HBV-related cirrhosis.Methods 1.Patients with advanced liver disease who received orthotopic liver transplantation(OLT)were included,from January 2012 to June 2015.Healthy examiners with same age and gender ratio were selected as normal control group at the same period.The echocardiographic results of patients and healthy examiners were recorded.2.Patients who received OLT were included in this study from January 2012 to June 2015.According to the 2015 ESC/ERS guidelines for the diagnosis of pulmonary hypertension(PH),tricuspid regurgitation velocity(TRV)and other echocardiographic PH signs were used for the diagnosis of PH.Patients with portal hypertension and without other known causes of PH were diagnosed as Po PH.Clinical characteristics and prognosis of Po PH patients were compared with those of non-Po PH patients.3.Patients with HBV-related cirrhosis without other known cardiac disease who underwent OLT from May 2014 to April 2016 were included.Patients' echocardiographic and ECG results were recorded.According to the expert consensus of 2005 World Congress of Gastroenterology at Montreal,patients with systolic or diastolic dysfunction were diagnosed as cirrhotic cardiomyopathy(CCM),and patients with QTc>440ms were diagnosed as QTc interval prolongation.The prevalence,clinical characteristics and prognosis of patients with CCM or QTc interval prolongation were investigated.Results 1.A total of 223 patients with advanced liver disease and 50 healthy examiners(control group)were included.There were no significant difference in age(p=0.14)and gender ratio(p=0.79)between patients and control group.Compared with control group,patients with advanced liver disease had lower systolic blood pressure(p=0.02),higher heart rate(p=0.14),increased EF(67.1±7.4 vs 64.7±5.7,p=0.03)and CO(6.1±1.9 L/min vs 4.8±1 L/min,p<0.001).Echocardiography results showed that compared with control group,patients with advanced liver disease had higher A velocity(71.2±6.3 cm/s vs 62.5±5.4 cm/s,p=0.01),lower E velocity(69.7±10.7 cm/s vs 87.2±8.3 cm/s,p=0.04)and E/A ratio(0.9 ± 0.4 vs 1.1 ± 0.1,p=0.007);they also had significantly increased aortic root inside diameter(p<0.001),left atrial diameter(p<0.001),interventricular septal thickness(p=0.02),left ventricular end-diastolic diameter(p<0.001),left ventricular posterior wall thickness(p=0.01)and pulmonary artery diameter(p<0.001).2.A total of 223 middle aged(50.9±9 years-old),mostly male(76.2%)patients were included,162 patients(72.6%)with HBV infection.14 patients(6.3%)were diagnosed with Po PH and none of them was treated with vasodilators before or after OLT.Compared with non-Po PH patients,Po PH patients had higher proportion of female(50% vs 22%,p=0.03)and iron-deficiency anemia(43% vs 18%,p=0.03);longer duration of liver disease(17.1±5.8 years vs 12.1±7.3 years,p=0.01),higher Child-Pugh score [9(6-11)vs 7(5-12),p=0.001] and MELD score(19.4 ±7.3 vs 14 ±7.1,p=0.006).Multivariate Logistic regression analysis showed that female(OR=3.76,p=0.04),duration of liver disease(OR=1.10,p=0.02),middle or severe anemia(OR=4.27,p=0.02)and iron-deficiency anemia(OR=1.04,p=0.01)were independent risk factors of Po PH.After OLT,patients were followed up for 26±13.5 months.Compared with non-Po PH patients,Po PH patients had a significantly lower cumulative survival rate(6 months,1 year,2 year survival rates were 64% vs 89%,50% vs 85%,43% vs 82%,respectively,p<0.001,HR 16.7),and the median survival time after surgery was 11.4 months.3.A total of 71 middle aged(49.0±8.4 years),mostly male(83.1%)patients with HBV-related cirrhosis were included.CCM was diagnosed in 20 patients(28.2%),and 27 patients(38%)had QTc interval prolongation.Compared with patients with normal QTc interval,patients with QTc interval prolongation had significantly increased Child-Pugh score [8(5-12)vs 6(5-10),p=0.003] and MELD score(14.5±6.3 vs 10.5±4.5,p=0.006).Patients were followed up for 14±6.6 months.Compared with preoperative values,at the end of follow up,patients' QTc interval(394.8±21.0ms vs 432.0±18.8ms,p<0.001),CO (5.3±1.9L/min vs 6.6±2.3L/min,p=0.001),heart rate(p=0.02),E/e' ratio(6.4±1.8 vs 7.4±3.4,p=0.03)and DT(172.6±39.7ms vs 187.3±39.0 ms,p=0.04)were significantly decreased;S velocity(11.8±2.6cm/s vs 10.6±1.8cm/s,p=0.004),E velocity(79±18.5cm/s vs 71.1±11.0cm/s,p=0.01)and E/A ratio(1.2±0.3 vs 1.0±0.2,p=0.04)were significantly increased.Survival curve analysis showed a lower cumulative survival rate in patients with prolonged QTc interval(6 months,1 year,2 year survival rates were 74% vs 93%,68% vs 90%,61% vs 90%,p=0.01,HR 4.11).Conclusion Compared with healthy people,patients with advanced liver disease had hyperdynamic state with left ventricular diamter and left ventricular wall thickness increased.The prevalence of Po PH was 6.3% in OLT recipients.Compared with non-Po PH patients,Po PH patients had a higher proportion of female and more serious liver disease.Female,longer duration of liver disease,middle or severe anemia and iron-deficiency anemia increased the risk of Po PH.The prognosis of Po PH patients without vasodilators therapy was poor after OLT,and the median survival time after surgery was only 11.4 months.CCM and QTc interval prolongation occurred frequently in liver transplant recipients with HBV-related cirrhosis.Compared with normal QTc interval patients,patients with QTc interval prolongation had more serious liver disease and poor prognosis.At the end of 14 months' follow up period,patients' cardiac function were significantly improved,and almost all patients' QTc interval returned to normal. |
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