Left ventricular dyssynchrony in patients with end-stage liver disease

Wael AlJaroudi, Himanshu Aggarwal, Fahad Iqbal, Jaekyeong Heo, Ami E. Iskandrian

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Background. Limited published data suggested that patients with end-stage liver disease (ESLD) might have "cirrhotic cardiomyopathy," which could have an earlier stage manifested by mechanical dyssynchrony before left ventricular (LV) dysfunction. Methods and Results. We studied consecutive patients with ESLD who had a stress-gated Tc-99m sestamibi myocardial perfusion imaging between 2008 and 2010 prior to liver transplant. Patients with LVEF <50%, abnormal perfusion, or QRS ≥ 120 ms were excluded. Baseline demographics, co-morbidities, model for ESLD (MELD) score, LV volumes, mass, ejection fraction (EF), and dyssynchrony indices (standard deviation and bandwidth) were extracted. The phase indices were compared to a normal cohort. There were 179 patients with a mean age 53 ± 8 years, LVEF 72 ± 10%. Hepatitis C, non-alcoholic steatohepatitis, and alcohol abuse were the most common cause of liver cirrhosis (40%, 18%, and 14%, respectively). Patients with ESLD had similar standard deviation (14 ± 8vs 15 ± 6, P 5 NS) and bandwidth (41 ± 25vs 42 ± 14, P 5 NS) to the normal cohort. Only four patients (2%) had a standard deviation >27 (mean 1 2 SD of the control group). The phase standard deviations and bandwidth similar in patients with MELD scores of ≤ 10, 11-18, 19-24, and ≥ 25 (P 5 NS for both). There was no correlation between the MELD score and standard deviation or bandwidth (r 5 20.044 and 20.068, respectively, P 5 NS for both). Also, there was no correlation between the QTc and dyssynchrony indices. After 1-year follow-up, 22 patients died (12%). The dyssynchrony indices were similar among those who died and those who survived. Conclusion. Patients with ESLD and normal EF have no evidence for LV dyssynchrony.

Original languageEnglish (US)
Pages (from-to)451-455
Number of pages5
JournalJournal of Nuclear Cardiology
Volume18
Issue number3
DOIs
StatePublished - May 2011
Externally publishedYes

Keywords

  • Dyssynchrony
  • End-stage liver disease
  • Gated SPECT
  • MELD score
  • Phase analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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