Camila Maestas1, Mohamad Lazkani2, Michael Sultan3, Geetha Kolli4, Maheen Sheikh5, Madhavgopal Cherukuri6. 1. Internal Medicine Resident, Department of Internal Medicine, Banner University Medical Center-Phoenix, Arizona 85006, USA. Electronic address: Camila.Maestas@Bannerhealth.com. 2. Structural Heart Fellow, Department of Cardiology, Banner University Medical Center-Phoenix, Arizona 85006, USA. Electronic address: mohamadlazkani@gmail.com. 3. Cardiovascular Disease Fellow, Department of Cardiology, Banner University Medical Center-Phoenix, Arizona 85006, USA. Electronic address: Michaelsultan@gmail.com. 4. Attending Physician, Hepatology, Department of Gastroenterology, Banner University Medical Center-Phoenix, Arizona 85006, USA. Electronic address: Geetha.Kolli@bannerhealth.com. 5. Attending Physician, Department of Gastroenterology, Banner University Medical Center-Phoenix, Arizona 85006, USA. Electronic address: Maheen.S.Sheikh@gmail.com. 6. Attending Physician, Interventional Cardiology, Department of Cardiology, Banner University Medical Center-Phoenix, Arizona 85006, USA. Electronic address: Madhavgopal.Cherukuri@bannerhealth.com.
Abstract
INTRODUCTION: Acute decompensated heart failure is a known complication following orthotopic liver transplant. Among those, there are some cases of takostubo type cardiomyopathy (TC), commonly referred to as "broken heart syndrome". While the exact mechanism of TC is unknown, it frequently proceeds a physical or emotional stressor. Here we present a series of seven cases of TC following orthotopic liver transplant. METHODS: A retrospective chart review was conducted on 454 patients were identified as having post-operative cardiac dysfunction in the setting of orthotopic liver transplantation. Of those, seven were identified as having TC based on apical ballooning, acute heart failure without evidence of coronary artery disease. All seven underwent pre-operative cardiac evaluation per protocol. Extensive chart review was performed on the seven patients to identify pre and post-operative qualities. RESULTS: At this single institution, TC affected 7/454 patients, reflecting an incidence of 1.5% over the eight year study period. Of the seven patients affected, one expired. Patients represented a mix of emergent and scheduled transplantation in the setting of end stage liver disease (ESLD). Patients had a mix of etiologies related to their ELSD including hepatitis C, alcoholic cirrhosis, and non-alcoholic steatohepatitis. DISCUSSION: It is important to recognize TC as a potential complication following liver transplantation so as to detect cases earlier in the disease course and begin early goal-directed care.
INTRODUCTION: Acute decompensated heart failure is a known complication following orthotopic liver transplant. Among those, there are some cases of takostubo type cardiomyopathy (TC), commonly referred to as "broken heart syndrome". While the exact mechanism of TC is unknown, it frequently proceeds a physical or emotional stressor. Here we present a series of seven cases of TC following orthotopic liver transplant. METHODS: A retrospective chart review was conducted on 454 patients were identified as having post-operative cardiac dysfunction in the setting of orthotopic liver transplantation. Of those, seven were identified as having TC based on apical ballooning, acute heart failure without evidence of coronary artery disease. All seven underwent pre-operative cardiac evaluation per protocol. Extensive chart review was performed on the seven patients to identify pre and post-operative qualities. RESULTS: At this single institution, TC affected 7/454 patients, reflecting an incidence of 1.5% over the eight year study period. Of the seven patients affected, one expired. Patients represented a mix of emergent and scheduled transplantation in the setting of end stage liver disease (ESLD). Patients had a mix of etiologies related to their ELSD including hepatitis C, alcoholic cirrhosis, and non-alcoholic steatohepatitis. DISCUSSION: It is important to recognize TC as a potential complication following liver transplantation so as to detect cases earlier in the disease course and begin early goal-directed care.