Anesth Pain Med.  2019 Oct;14(4):465-473. 10.17085/apm.2019.14.4.465.

Preoperative echocardiographic evaluation of cardiac systolic and diastolic function in liver transplant recipients with diabetes mellitus: a propensity-score matched analysis

• Kwon HM
• Jeong Y
• Kim KS
• Jung KW
• Moon YJ
• Hwang GS

• KMID: 2465347
• DOI: http://doi.org/10.17085/apm.2019.14.4.465

Abstract

BACKGROUND
Diabetes mellitus (DM) increases risk of heart failure. It has been shown that diabetes leads to DM-cardiomyopathy, characterized by systolic and diastolic dysfunction. Pre-transplant diastolic dysfunction, has been associated with poor graft outcome and mortality. We assessed the hypothesis that end-stage liver disease (ESLD) patients with diabetes (DM-ESLD), have more advanced cardiac systolic and diastolic dysfunction, compared to ESLD patients without diabetes (Non DM-ESLD).
METHODS
We retrospectively evaluated preoperative echocardiography of 1,319 consecutive liver transplant recipients (1,007 Non DM-ESLD vs. 312 DM-ESLD [23.7%]) January 2012-May 2016. Systolic and diastolic indices, such as left ventricular ejection fraction, transmital E/A ratio, tissue doppler s"², e"² velocity, and E/e"² ratio (index of left ventricular end-diastolic pressure), were compared using 1:2 propensity-score matching.
RESULTS
DM-ESLD patients showed no differences in systolic indices of left ventricular ejection fraction and s"² velocity, whereas diastolic indices of E/A ratio ≤ 1 (49.0% vs. 40.2% P = 0.014), e"² velocity (median = 7.0 vs. 7.4 cm/s, P < 0.001) and E/e"² ratio (10.9 ± 3.2 vs. 10.1 ± 3.0, P < 0.001), showed worse diastolic function compare with Non DM-ESLD patients, respectively.
CONCLUSIONS
DM-ESLD patients suffer higher degree of diastolic dysfunction compared with Non DM-ESLD patients. Based on this, careful preoperative screening for diastolic dysfunction in DM-ESLD patients is encouraged, because poor transplant outcomes have been noted in patients with preoperative diastolic dysfunction.

Keyword

Diabetes mellitus; Diastolic heart failure; Echocardiography; Liver cirrhosis; Propensity score; Systolic heart failure

MeSH Terms

Diabetes Mellitus*
Echocardiography*
Heart Failure
Heart Failure, Diastolic
Heart Failure, Systolic
Humans
Liver Cirrhosis
Liver Diseases
Liver*
Mass Screening
Mortality
Propensity Score
Retrospective Studies
Stroke Volume
Transplant Recipients*
Transplants

Figure

• 

  Fig. 1 Representative of echocardiographic measurement of (A) transmitral peak E velocity, peak A velocity and (B) tissue doppler image of s’, e’ and a’ velocity. DT: deceleration time, PHT: pressure half-time.

• 

  Fig. 2 Comparison of systolic function in matched set. Density histograms depict frequency of (A) left ventricular ejection fraction and (B) tissue Doppler s’ velocity. Vertical dashed lines show mean value for left ventricular ejection fraction and median for tissue doppler s’ velocity (both P > 0.1).

• 

  Fig. 3 Comparison of diastolic function in matched set. Density histograms depict frequency of (A) transmitral E/A ratio, (B) E/e’ ratio and (C) tissue doppler e’ velocity. Vertical dashed lines show median value for E/A ratio and e’ velocity while mean values for E/e’ ratio (all P < 0.001).

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