Congestive heart failure following liver transplantation: Echocardiographic predictors and response to therapy

Aim: To determine whether transthoracic echocardiography (TIB) can predict postoperative congestive heart failure (CHF) after liver transplantation in patients without known heart disease. Methods: Retrospective case-control study of seven patients who developed CHF after liver transplantation and 8 matched controls (C) (age 46±14 and 47±9 yrs, respectively) who did not develop CHF. Results: Patients with CHF were noted to have clinical and radiographic evidence of pulmonary edema (7/7 and pts) and significant reduction in LVEF (32±9%) from two to 126 days postoperatively. On preoperative TTE. CHF pts and the controls demonstrated similar LVEF (62±11 vs. 67±8) and end-diastolic volume index (EDVT) (89 ml/m2±33 vs. 68±37). However, CHF pts demontrated greater left left ventricular mass index (LVMI) (123 gm/m2±42 vs. 81±14 p ≤ 0.03), a greater incidence of LVH (83% vs 0%) and a trend toward a greater end-systolic volume index (ESVI) (35 ml/m2±15 vs. 22±10 p = 0.08). All CHF patients were treated with diuretics and vasodilator therapy (hydralazine and nitrates), resulting in resolution in signs and symptoms of CHF and improvement of LVEF (32±9% vs 59±10%). Conclusions: Patients who develop CHF after liver transplantation have similar preoperative systolic LV function but have a significantly increased LVMI. Treatment results in clinical improvement and restoration of systolic LV function. The value of TTE for predicting CHF following liver transplantation should be prospectively evaluated.