BACKGROUND: Limited published data suggested that patients with end-stage liver disease (ESLD) might have "cirrhotic cardiomyopathy," which could have an earlier stage manifested by mechanical dyssynchrony before left ventricular (LV) dysfunction. METHODS AND RESULTS: We studied consecutive patients with ESLD who had a stress-gated Tc-99m sestamibi myocardial perfusion imaging between 2008 and 2010 prior to liver transplant. Patients with LVEF < 50%, abnormal perfusion, or QRS ≥ 120 ms were excluded. Baseline demographics, co-morbidities, model for ESLD (MELD) score, LV volumes, mass, ejection fraction (EF), and dyssynchrony indices (standard deviation and bandwidth) were extracted. The phase indices were compared to a normal cohort. There were 179 patients with a mean age 53 ± 8 years, LVEF 72 ± 10%. Hepatitis C, non-alcoholic steatohepatitis, and alcohol abuse were the most common cause of liver cirrhosis (40%, 18%, and 14%, respectively). Patients with ESLD had similar standard deviation (14 ± 8° vs 15 ± 6°, P = NS) and bandwidth (41 ± 25° vs 42 ± 14°, P = NS) to the normal cohort. Only four patients (2%) had a standard deviation >27° (mean + 2 SD of the control group). The phase standard deviations and bandwidth similar in patients with MELD scores of ≤10, 11-18, 19-24, and ≥25 (P = NS for both). There was no correlation between the MELD score and standard deviation or bandwidth (r = -0.044 and -0.068, respectively, P = NS for both). Also, there was no correlation between the QTc and dyssynchrony indices. After 1-year follow-up, 22 patients died (12%). The dyssynchrony indices were similar among those who died and those who survived. CONCLUSION: Patients with ESLD and normal EF have no evidence for LV dyssynchrony.
BACKGROUND: Limited published data suggested that patients with end-stage liver disease (ESLD) might have "cirrhotic cardiomyopathy," which could have an earlier stage manifested by mechanical dyssynchrony before left ventricular (LV) dysfunction. METHODS AND RESULTS: We studied consecutive patients with ESLD who had a stress-gated Tc-99m sestamibi myocardial perfusion imaging between 2008 and 2010 prior to liver transplant. Patients with LVEF < 50%, abnormal perfusion, or QRS ≥ 120 ms were excluded. Baseline demographics, co-morbidities, model for ESLD (MELD) score, LV volumes, mass, ejection fraction (EF), and dyssynchrony indices (standard deviation and bandwidth) were extracted. The phase indices were compared to a normal cohort. There were 179 patients with a mean age 53 ± 8 years, LVEF 72 ± 10%. Hepatitis C, non-alcoholic steatohepatitis, and alcohol abuse were the most common cause of liver cirrhosis (40%, 18%, and 14%, respectively). Patients with ESLD had similar standard deviation (14 ± 8° vs 15 ± 6°, P = NS) and bandwidth (41 ± 25° vs 42 ± 14°, P = NS) to the normal cohort. Only four patients (2%) had a standard deviation >27° (mean + 2 SD of the control group). The phase standard deviations and bandwidth similar in patients with MELD scores of ≤10, 11-18, 19-24, and ≥25 (P = NS for both). There was no correlation between the MELD score and standard deviation or bandwidth (r = -0.044 and -0.068, respectively, P = NS for both). Also, there was no correlation between the QTc and dyssynchrony indices. After 1-year follow-up, 22 patients died (12%). The dyssynchrony indices were similar among those who died and those who survived. CONCLUSION:Patients with ESLD and normal EF have no evidence for LV dyssynchrony.
Authors: Christopher L Hansen; Richard A Goldstein; Olakunle O Akinboboye; Daniel S Berman; Elias H Botvinick; Keith B Churchwell; C David Cooke; James R Corbett; S James Cullom; Seth T Dahlberg; Regina S Druz; Edward P Ficaro; James R Galt; Ravi K Garg; Guido Germano; Gary V Heller; Milena J Henzlova; Mark C Hyun; Lynne L Johnson; April Mann; Benjamin D McCallister; Robert A Quaife; Terrence D Ruddy; Senthil N Sundaram; Raymond Taillefer; R Parker Ward; John J Mahmarian Journal: J Nucl Cardiol Date: 2007 Nov-Dec Impact factor: 5.952
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Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: Mark A Trimble; Salvador Borges-Neto; Emily F Honeycutt; Linda K Shaw; Robert Pagnanelli; Ji Chen; Ami E Iskandrian; Ernest V Garcia; Eric J Velazquez Journal: J Nucl Cardiol Date: 2008 Sep-Oct Impact factor: 5.952
Authors: Mark A Trimble; Salvador Borges-Neto; Stuart Smallheiser; Ji Chen; Emily F Honeycutt; Linda K Shaw; Jaekyeong Heo; Robert A Pagnanelli; E Lindsey Tauxe; Ernest V Garcia; Fabio Esteves; Frank Seghatol-Eslami; G Neal Kay; Ami E Iskandrian Journal: J Nucl Cardiol Date: 2007-04-18 Impact factor: 5.952