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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23266    [Epub ahead of print]
Published online July 12, 2023.
Postoperative alterations in ventriculoarterial coupling are an indicator of cardiovascular outcomes in liver transplant recipients
Ji Yeon Kim1, Young-Jin Moon2, Changjin Lee3, Jin Ho Kim3, Junghyun Park3, Jung-Won Kim4
1Department of Anesthesiology and Pain Medicine, CHA Gangnam Medical Center, CHA University School of Medicine
2Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine
3Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine
4Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, CHA Bundang Medical Center, CHA University School of Medicine
Corresponding author:  Jung-Won Kim, Tel: 82-31-780-5157, Fax: 82-31-780-5157, 
Email: mint3131@cha.ac.kr
Received: 5 April 2023   • Revised: 23 June 2023   • Accepted: 6 July 2023
Liver transplantation (LT) increases the heart and vessel workload in patients with cirrhotic cardiomyopathy. While the interaction of the left ventricle (LV) with the arterial system (ventriculoarterial coupling, VAC) is a key determinant of cardiovascular performance, little is known about changes in VAC after LT. Therefore, we evaluated the relationship between VAC after LT and cardiovascular outcomes.
44 consecutive patients underwent echocardiographic assessments before and within 30 days after LT. Non-invasive arterial elastance (Ea), LV end-systolic elastance (Ees), and LV end-diastolic elastance (Eed) were calculated. The postoperative outcomes included the development of major adverse cardiovascular events (MACE) and the length of stay in the intensive care unit (ICU) and hospital.
A total of 240 patients were included in the analyses. After LT, Ea increased by 16% (P < 0.001), and Ees and contractility index of systolic velocity (S') increased by 18% (P < 0.001) and 7% (P < 0.001), respectively. The Eed increased by 6% (P < 0.001). The VAC remained unchanged (0.56 to 0.56, P = 0.912). Of these patients, 29 had MACE, and those with MACE had significantly higher postoperative VAC. Additionally, a higher postoperative VAC was an independent risk factor for a longer postoperative hospital stay (P = 0.038).
These data suggest that ventriculoarterial decoupling is associated with poor postoperative outcomes after LT.
Key Words: Cirrhotic cardiomyopathy; Echocardiography; Liver transplantation; Major adverse cardiovascular events; Postoperative outcome; Ventriculoarterial coupling
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