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KMID : 0356920240770020217
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Korean Journal of Anesthesiology
2024 Volume.77 No. 2 p.217 ~ p.225
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Postoperative alterations in ventriculoarterial coupling are an indicator of cardiovascular outcomes in liver transplant recipients
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Kim Ji-Yeon
Moon Young-Jin
Lee Chang-Jin
Kim Jin-Ho
Park Jung-Hyun
Kim Jung-Won
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Abstract
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Background: Liver transplantation (LT) increases the heart and vessel workload in patients with cirrhotic cardiomyopathy. While the interaction of the left ventricle (LV) with the arterial system (ventriculoarterial coupling, VAC) is a key determinant of cardiovascular performance, little is known about changes in VAC after LT. Therefore, we evaluated the relationship between VAC after LT and cardiovascular outcomes.
Methods: 344 consecutive patients underwent echocardiographic assessments before and within 30 days after LT. Non-invasive arterial elastance (Ea), LV end-systolic elastance (Ees), and LV end-diastolic elastance (Eed) were calculated. The postoperative outcomes included the development of major adverse cardiovascular events (MACE) and the length of stay in the intensive care unit and hospital.
Results: A total of 240 patients were included in the analyses. After LT, Ea increased by 16% (P < 0.001), and Ees and contractility index of systolic velocity (S') increased by 18% (P < 0.001) and 7% (P < 0.001), respectively. The Eed increased by 6% (P < 0.001). The VAC remained unchanged (0.56 to 0.56, P = 0.912). Of these patients, 29 had MACE, and those with MACE had significantly higher postoperative VAC. Additionally, a higher postoperative VAC was an independent risk factor for a longer postoperative hospital stay (P = 0.038).
Conclusions: These data suggest that ventriculoarterial decoupling is associated with poor postoperative outcomes after LT.
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KEYWORD
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Cardiomyopathies, Echocardiography, Left ventricular dysfunction, Liver cirrhosis, Liver transplantation, Postoperative complications
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