Anesth Pain Med.  2017 Apr;12(2):159-164. 10.17085/apm.2017.12.2.159.

Pretransplant diastolic wall strain assessed by transthoracic echocardiography and its implication on posttransplant survival rate in liver transplantation

• Sang BH
• Kim JW
• Yoo JI
• Bang YS
• Choi YS
• Moon YJ
• Hwang GS
• Lim YS

• KMID: 2379738
• DOI: http://doi.org/10.17085/apm.2017.12.2.159

Abstract

BACKGROUND
In cirrhotic patients, left ventricular diastolic dysfunction is associated with poor outcomes. Diastolic wall strain (DWS) is a new index of left ventricular diastolic function that correlates with the myocardial stiffness. In this study, we aimed to determine whether DWS calculated from preoperative transthoracic echocardiography can predict the survival of liver transplantation recipients.
METHODS
A total of 981 patients who underwent liver transplantation were enrolled. We collected the clinical, laboratory and echocardiographic data retrospectively. The left ventricular posterior wall thickness at end-systole (LVPWs) and end-diastole (LVPWd) were measured using M-mode imaging. DWS was calculated as follows: DWS = (LVPWs - LVPWd) / LVPWs. As previously reported, DWS ≤ 0.33 was defined as low DWS and DWS > 0.33 was defined as normal DWS. The primary outcome of this study was 2-years survival after liver transplantation.
RESULTS
The 2-years mortality rate following liver transplantation was higher in low DWS group than normal DWS group (14.6% vs.10.0%, P = 0.038). In univariate Cox regression analysis, age, model for end-stage liver disease score, Child-Turcotte-Pugh score, creatinine, b-type natriuretic peptide, heart rate, left ventricular end-diastolic volume index, left ventricular stroke volume index, left ventricular ejection fraction, E/A ratio, e"², E/e"² ratio, and DWS were associated with 2-years survival after liver transplantation. In multivariate Cox regression analysis, DWS was an independent predictor of 2-years survival after adjusting significant univariate covariates.
CONCLUSIONS
This study results indicated that the DWS is an independent prognostic predictor in liver transplantation recipients.

Keyword

Diastole; Liver transplantation; Survival; Transthoracic echocardiography

MeSH Terms

Creatinine
Diastole
Echocardiography*
Heart Rate
Humans
Liver Diseases
Liver Transplantation*
Liver*
Mortality
Natriuretic Peptide, Brain
Retrospective Studies
Stroke Volume
Survival Rate*
Creatinine
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1 Measurement of the diastolic wall strain (DWS) from M-mode echocardiography. Left panel: In parasternal long axis view, M-mode echocardiography of left ventricular posterior wall was measured. Right panel: Left ventricular posterior wall thickness at end systole (LVPWs) and left ventricular posterior wall at enddiastole (LVPWd) were indicated. DWS was calculated as follows: DWS = (LVPWs − LVPWd) / LVPWs.

• 

  Fig. 2 Kaplan-Meier survival curves. The survival rate of patients with diastolic wall strain (DWS) ≤ 0.33 was significantly lower than those with DWS > 0.33 (log-rank test, P = 0.038).

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