한빛사논문
- 조회963
Abstract
Won-Jung Shina, Jun-Gol Songa, In-Gu Juna, Young-Jin Moona, Hye-Mee Kwona, Kyeowoon Junga, Seon-Ok Kimb, Gyu-Sam Hwanga,*
a Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
b Department of Clinical Epidemiology and Biostistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Corresponding author at: Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
*Corresponding author
Abstract
Background and aims
Ventriculo-arterial coupling (VAC) reflects the interaction between ventricular performance and effective arterial load. Current criteria for cirrhotic cardiomyopathy focus only on cardiac function without addressing the effect of hyperdynamic, low-resistance circulation. We investigated alterations in VAC in cirrhotic patients and their associations with post-liver transplant all-cause mortality.
Methods
In this single institution cohort study, cirrhotic patients who underwent liver transplantation (LT) (n = 914) were retrospectively compared with healthy matched controls using noninvasively measured end-systolic ventricular elastance (Ees), arterial elastance (Ea), and VAC (Ea/Ees). All-cause mortality based on VAC values were investigated using a Cox hazard model with the inverse probability treatment weighting (IPTW) of propensity score.
Results
Cirrhotic patients had significantly lower Ees, Ea and VAC values than controls. Over a median of 30 months, 96 patients died after LT. In patients with a high Model for End-stage Liver Disease score (⩾25), VAC of >0.61 (highest tertile) had poorer survival outcomes than patients with VAC of ⩽0.50 (lowest tertile) (66.0% vs. 91.8%; log-rank P = 0.001), and was independently associated with risk of mortality (hazard ratio, 2.44; 95% confidence interval, 1.10-5.39; P = 0.028) compared with VAC of ⩽0.61 after IPTW adjustment.
Conclusions
In cirrhotic patients, ventricular elastance and VAC values are lower than those in controls. However, in advanced cirrhotic patients, an increase in VAC value is associated with all-cause mortality after LT, suggesting that this noninvasive estimation of ventriculo-arterial uncoupling is an additional novel prognosticator in cirrhotic cardiovascular disorders.
논문정보
- Research article
- 2016년 09월 (BRIC 등록일 2016-10-05)
- 국내 연구진
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