Abstract Body (Do not enter title and authors here): Introduction: Diastolic dysfunction may prognosticate adverse cardiovascular outcomes post-liver transplantation (LT). However, the impact of diastolic dysfunction on post-transplant outcomes has not been thoroughly investigated. We sought to determine the prognostic utility of baseline echocardiographic abnormalities on post-LT outcomes.
Methods: A retrospective cohort study was conducted on adult patients who underwent LT at Lahey Hospital (2015-2020), followed until 2023 for major adverse cardiovascular events (MACE) and mortality. Diastolic dysfunction was assessed per 2016 ASE guidelines: septal e' < 7 cm/s; lateral e' < 10 cm/s; E/e' ≥ 15; Left atrial volume index > 34 ml/m²; Tricuspid Regurgitation velocity > 2.8 m/s. with 0 or 1 abnormal parameter considered normal, 2 abnormal parameters were categorized as indeterminate, and ≥3 as diastolic dysfunction.
Results: LT was performed in 423 patients (mean age 56.4 ± 9.62; 67.4% male), mainly for alcohol cirrhosis (36%), metabolic dysfunction-associated steatotic liver disease (16%), and liver malignancy (15%). Pre-operative echocardiography was conducted a median of 3 days before LT evaluation. Ejection fraction (EF) was 65 ± 4.5%; no patient had EF < 50%. Diastolic dysfunction was noted in 17 patients. 363 had normal diastolic function and 44 indeterminate diastolic function.
Over 3 years post-LT, 70 patients died (5 cardiovascular deaths), and 48 experienced MACE: 21 hospitalizations for acute heart failure, 8 nonfatal myocardial infarctions, 14 cerebrovascular events, and 5 cardiovascular deaths. Mortality and MACE rates did not differ significantly between patients with normal diastolic function (16.8% and 13.2%), indeterminate (13.6% and 9.1%), or diastolic dysfunction (18.8% and 18.8%, p=0.84 and p=0.58 respectively). However, a higher proportion of patients who experienced MACE had a history of atrial fibrillation (AF) (33% vs. 14%, p < 0.001) and CAD before LT listing (31% vs. 9%, p < 0.001), despite 60% of patients with MACE and CAD undergoing revascularization.
Conclusion: In this cohort, diastolic dysfunction did not appear predictive of all-cause mortality or adverse cardiac events post-LT, suggesting it may not be a sensitive marker for post-LT cardiovascular complications. In contrast, patients with prior AF and CAD history are at higher risk, indicating a need for further studies to evaluate if these conditions should preclude LT.