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Lai Q, Caimano M, Canale F, Birtolo LI, Ferri F, Corradini SG, Mancone M, Marrone G, Pedicino D, Rossi M, Vernole E, Pompili M, Biolato M. The role of echocardiographic assessment for the risk of adverse events in liver transplant recipients: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100838. [PMID: 38417399 DOI: 10.1016/j.trre.2024.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND & AIMS Echocardiographic findings may provide valuable information about the cardiac conditions in cirrhotic patients waiting for liver transplantation (LT). However, data on the ability of the different echocardiographic parameters to predict post-transplant risk of mortality are scarce and heterogeneous. This systematic review evaluates the role of different echocardiographic features as predictors of post-LT mortality. A meta-analysis was also performed according to the observed results. METHODS A systematic review was conducted according to PRISMA guidelines. Medline (PubMed) database was searched through February 2023 for relevant published original articles reporting the prognostic value of echocardiographic findings associated with outcomes of adult LT recipients. The risk of bias in included articles was assessed using ROBINS-E tool. Methodological quality varied from low to high across the risk of bias domains. RESULTS Twenty-three studies were identified after the selection process; ten were enrollable for the meta-analyses. According to the results observed, the E/A ratio fashioned as a continuous value (HR = 0.43, 95%CI = 0.25-0.76; P = 0.003), and tricuspid regurgitation (HR = 2.36, 95%CI = 1.05-5.31; P = 0.04) were relevant predicting variables for post-LT death. Other echocardiographic findings failed to merge with statistical relevance. CONCLUSION Tricuspid regurgitation and left ventricular diastolic dysfunction play a role in the prediction of post-LT death. More studies are needed to clarify further the impact of these echocardiographic features in the transplantation setting.
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Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
| | - Miriam Caimano
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesca Canale
- General Surgery and Organ Transplantation Unit, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Flaminia Ferri
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I Policlinico of Rome, Rome, Italy
| | - Stefano Ginanni Corradini
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I Policlinico of Rome, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Giuseppe Marrone
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Elisabetta Vernole
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Maurizio Pompili
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Marco Biolato
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome, Italy
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González-Suárez S, Corbett M, Hernández-Martínez A. Impact of graft reperfusion on cardiac function assessed by transesophageal echocardiography during liver transplantation: an observational retrospective study. J Clin Monit Comput 2024; 38:301-311. [PMID: 38032448 PMCID: PMC10995086 DOI: 10.1007/s10877-023-01110-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
Cardiovascular instability is common during the reperfusion phase of orthotopic liver transplantation (OLT), and some patients experience a postreperfusion syndrome (PRS). However, there are no reports comparing the cardiac dysfunction between patients with PRS and those without. Thus, the aim of this study was to evaluate cardiac dysfunction in patients exhibiting PRS. This observational retrospective study included 34 patients who underwent OLT and were monitored with transesophageal echocardiography (TEE). The right ventricular/left ventricular (RV/LV) end diastolic area, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF) by Simpson method, pulsed Doppler of the mitral valve, and tissue Doppler motion of the mitral annulus were determined. Echocardiographic measurements were registered at the beginning of surgery and at 1 and 30 min after vascular unclamping. Patients with PRS (PRS group) were identified, and their echocardiographic parameters of ventricular function were compared with those in patients without PRS (non-PRS group). To check the evolution of diastolic-systolic dysfunction, general linear model-repeated measures were estimated. No patient presented systolic/diastolic dysfunction on the basal echocardiogram. One minute after vascular unclamping, the incidence of RV dilation was 4.5 times greater in patients with PRS (Cramer´s V > 0.6), and the incidence of RV systolic dysfunction was 62.5% in patients with PRS compared to 15.40% in patients without PRS (Cramer´s V = 0.45). The incidence of LV systolic dysfunction was 25% in patients with PRS compared to 0% in those without (Cramer´s V = 0.45), and left ventricular diastolic dysfunction was 4.8 times greater in patients with PRS (Cramer´s V = 0.45). No patient presented diastolic dysfunction type III. There were significant differences between groups in the evolutionary pattern at 1 and 30 min after unclamping for RV dilation (p = 0.008) and for TAPSE (p = 0.014). Liver graft reperfusion may alter cardiac function. Cardiac dysfunction was more frequent in patients with PRS. These patients exhibited temporary dysfunction of the RV associated with a varying degree of LV diastolic-systolic dysfunction. Trial registration: clinicaltrials.gov (NCT05175534). January 03, 2022; "retrospectively registered".
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Affiliation(s)
- Susana González-Suárez
- Department of Surgery, Universitat Autònoma de Barcelona, Unitat Docent Vall d´Hebron, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
- Department of Anesthesiology, Vall d´Hebron University Hospital, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
- Vall d´Hebron Institut de Recerca (VHIR), Cardiovascular diseases Research Group, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
| | - Matthew Corbett
- Department of Anesthesiology, Vall d´Hebron University Hospital, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain
| | - Alberto Hernández-Martínez
- Department of Anesthesiology and Intensive Care, Grupo Policlínica, Ibiza. Islas Baleares. Vía Romana s/n, Ibiza, Baleares, 07800, Spain
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Vetrugno L, Zanini V, Ventin M, Cherchi V, Baccarani U. Diastolic dysfunction and early liver allograft dysfunction: Like Oedipus. Echocardiography 2022; 39:918-919. [PMID: 35775094 DOI: 10.1111/echo.15409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Victor Zanini
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
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Raveh Y, Nicolau-Raducu R. Diastolic dysfunction and early liver allograft dysfunction. Echocardiography 2022; 39:959. [PMID: 35751385 DOI: 10.1111/echo.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yehuda Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Miami, Florida, USA
| | - Ramona Nicolau-Raducu
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Miami, Florida, USA
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