Enhanced sympathetic nervous activation and peripheral vasodilation in end‐stage liver disease (ESLD) may limit the importance of left ventricular ejection fraction (LVEF) as an influential prognosticator. We sought to comprehend the LVEF and cardiac dimensions in ESLD patients to define the LVEF threshold to predict all‐cause mortality after liver transplantation (LT). Data were collected prospectively from the Asan LT Registry between 2008 and 2016, and outcomes were retrospectively reviewed. LVEF, end‐diastolic volume index (EDVI) and end‐diastolic elastance (Eed) were measured by preoperative echocardiography. Of 2799 patients, 452 (16.2%) had LVEF≤60% with 29 (1.0%) having LVEF<55% and 269 (9.6%) had LVEF≥70%. Over a median of 5.4‐year follow‐up, 329 (11.8%) patients died: 104 (3.7%) died within 90 days. LVEF (range, 30–81%) was directly proportionate to Model for End‐stage Liver Disease (MELD) scores, an index of liver disease severity, in survivors but showed a fixed flat‐line pattern in non‐survivors (interaction P=0.004, between groups), with lower EDVI (P=0.013) and higher Eed (P=0.001) in MELD≥20 group. Patients with LVEF≤60% had higher a 90‐day (13% versus 7.4%, log‐rank P=0.03) and a median 5.4‐year (26.7% versus 16.2%, log‐rank P=0.003) mortality rates in MELD≥20 group, respectively, compared to those with LVEF>60%. Specifically, in MELD>35 group, a median 5.4‐year mortality rate was 53.3% in patients with LVEF≤60% versus 24% in those with LVEF>60% (log‐rank P<0.001). By contrast, mortality rates of LVEF≤60% and >60% were similar in MELD<20 group (log‐rank P=0.817).
LVEF≤60% is strongly associated with higher post‐LT mortality rates in MELD≥20 group, indicating the need to appraise both LVEF and liver disease severity simultaneously. Enhanced diastolic elastance with low EDVI insights into pathogenesis of low LVEF in non‐survivors with MELD≥20.
Keywords : Ejection fraction, Diastolic elastance, Mortality, Liver cirrhosis