Myocardial Remodeling and Liver Transplantation: the Results of Prospective Single-Center Study

Abstract

Objective: to determine structural and functional characteristics of the heart in patients with chronic terminal hepatopathy in need of transplantation and their dynamics in liver transplant recipients in the postoperative period. Materials and Methods. A single-center prospective cohort study was carried out. The observation period of patients with CTH was 5.4±3.29 years. Structural and hemodynamic parameters of the heart were measured by the method of echocardiography М-, В-modal and colored Doppler mode manufactured by General Electrics (USA) following the standard procedure. Results. The liver transplant recipients showed an enlargement of the left heart chambers and an increase in the myocardium mass index of the left ventricle (111.4±4.54 g/m 2 и 128.9±32.04 g/m 2 respectively, p<0.05), decrease in the diameter of the inferior vena cava (24.3±3.17 mm and 17.2±3.46 mm respectively, p<0.05) and of the right atrium volume index (62.3±11.76 ml/m 2 and 26.4±4.23 ml/m 2 respectively, p<0.01) in the long-term postoperative period in comparison with the initial examination results at the stage of putting them on the waiting list. Application of the method of 2D-Speckle Tracking Imaging enabled us to reveal reliable reduction of the global systolic longitudinal deformation of the right ventricle in the liver transplant recipients in comparison with the general population patients with metabolic syndrome (-17.6±1.48 % and -23.4±1.07 % respectively, p<0.01) and chronic ischemic heart disease (-16.4±1.61 % and -22.1±1.54 % respectively, p<0.01). The proportion of liver transplant recipients who showed a diastolic dysfunction of the left ventricle appeared to be higher in the study group than in the general population (70.7 % and 57.5 % respectively, p<0.05). The proportion of patients with the normal geometry of the left ventricle was lower among the liver transplant recipients in the long-term postoperative period in comparison with the patients from the general population with metabolic syndrome (22.1 % and 45.0 % respectively, p<0.01) and chronic ischemic heart disease (19.5 % and 40.0 % respectively, p<0.01). Conclusions. The results of the study provide evidence of the reverse development of cirrhotic cardiomyopathy manfestations and appearance of the signs of left ventricular remodeling after the orthotopic liver transplantation. The number of liver transplant recipients with metabolic syndrome, ischemic heart disease and diagnosed diastolic dysfunction of the left ventricle appeared to be higher in the study group than in the general population (70.7 % and 57.5 % respectively, p<0.05). Liver transplant recipients revealed the prevalence of disadaptive forms in the structure of remodeling: eccentric hypertrophy of the left ventricle (p<0.01), concentric remodeling (p<0.01) and dilatation hypertrophy of the left ventricle (p<0.01) in the long-term postoperative period in comparison with the patients from the general population.