Association of Cardiac Abnormalities to the Frail Phenotype in Cirrhotic Patients on the Waitlist: From the Functional Assessment in Liver Transplantation Study

Fecha de publicación: 01/03/2018

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

Chau, S
Dodson, JA
Mohamad, Y
Mustain, R
Lebsack, A
Lai, JC

Grupos

Hepatología experimental y Trasplante hepático

Investigador Principal

Laia Tolosa Pardo
Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

Background. Frailty is a syndrome of decreased physiologic reserve that results from compromise of multiple physiologic systems including cardiovascular system. We aimed to determine the association between the frail phenotype and cardiac abnormalities in liver transplant (LT) candidates through evaluation of transthoracic echocardiography (TTE) indices. Methods. Included were consecutive outpatients listed for LT who underwent a frailty assessment from January 1, 2014, to June 30, 2016 (using the Liver Frailty Index) and a 2-dimensional/Doppler TTE examination. Patients were categorized as robust, intermediate frail, or frail by the Liver Frailty Index based on scores of less than 3.2, between 3.2 and 4.5, or 4.5 or greater. Linear regression assessed associations between the Liver Frailty Index and TTE indices. Results. Of 335 patients, 19% were robust, 65% intermediate frail, and 16% frail. TTE indices of left atrial (LA) dilatation differed significantly by frailty status: median LA dimension (P = 0.03), LA volume index (LAVI mL/m(2); P < 0.001) and % LAVI > 34 mL/m(2) (P = 0.001). In linear regression adjusted for age, sex, hypertension, and diabetes, the Liver Frailty Index was positively associated with LA dimension (coeff, 0.20; 95% confidence interval [CI], 0.07-0.34), LAVI mL/m(2) (coeff, 0.01; 95% CI, 0.005-0.02), ejection fraction (coeff, 1.59; 95% CI, 0.32-2.85), and pulmonary artery systolic pressure (coeff, 0.01; 95% CI, 0.003-0.02), and negatively associated with LV hypertrophy (coeff, -0.22; 95% CI, -0.37 to -0.06). Conclusions. In LT candidates, frailty is associated with cardiac structural and functional changes, independent of known risk factors. Our study provides evidence to support that measures of frailty in cirrhotic patients encompass abnormalities of the cardiovascular system and may inform assessments of cardiovascular reserve in this population.

Datos de la publicación

ISSN/ISSNe:: 0041-1337, 1534-6080
Tipo:: Article
Páginas:: 101-107
DOI:: 10.1097/TP.0000000000002025
Factor de Impacto:: 1,904 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Puchades, L:: Hosp Univ & Politecn La Fe, Dept Gastroenterol, Hepatol Unit, Valencia, Spain
Chau, S:: Univ Calif San Francisco, Dept Med, Div Gastroenterol & Hepatol, 513 Parnassus Ave,UCSF Box 0538, San Francisco, CA 94143 USA
Dodson, JA:: NYU, Dept Med, Div Cardiol, Langone Med Ctr, 550 1St Ave, New York, NY 10016 USA
Mohamad, Y:: Univ Calif San Francisco, Dept Med, Div Gastroenterol & Hepatol, 513 Parnassus Ave,UCSF Box 0538, San Francisco, CA 94143 USA
Mustain, R:: Univ Calif San Francisco, Dept Med, Div Gastroenterol & Hepatol, 513 Parnassus Ave,UCSF Box 0538, San Francisco, CA 94143 USA
Lebsack, A:: Univ Calif San Francisco, Dept Med, Div Gastroenterol & Hepatol, 513 Parnassus Ave,UCSF Box 0538, San Francisco, CA 94143 USA
Aguilera, V:: Hosp Univ & Politecn La Fe, Dept Gastroenterol, Hepatol Unit, Valencia, Spain

Ctr Invest Biomed Red Enfermedades Hepat & Diages, Valencia, Spain
Prieto, M:: Hosp Univ & Politecn La Fe, Dept Gastroenterol, Hepatol Unit, Valencia, Spain

Ctr Invest Biomed Red Enfermedades Hepat & Diages, Valencia, Spain
Lai, JC:: Univ Calif San Francisco, Dept Med, Div Gastroenterol & Hepatol, 513 Parnassus Ave,UCSF Box 0538, San Francisco, CA 94143 USA

Keywords

SPECKLE-TRACKING ECHOCARDIOGRAPHY; VENTRICULAR DIASTOLIC FUNCTION; CARDIOVASCULAR RESPONSIVENESS; NONALCOHOLIC CIRRHOSIS; AMERICAN SOCIETY; DYSFUNCTION; DISEASE; RECOMMENDATIONS; ASCITES; ADULTS