Preoperative Echocardiographic Indices Associated With Elevated Brain Natriuretic Peptide in Liver Transplant Recipients
ABSTRACT Cardiac dysfunction may be present in patients with liver cirrhosis. Brain natriuretic peptide (BNP) concentration is a widely used biomarker for heart failure. We evaluated whether elevated BNP reflects cardiac dysfunction, as assessed by preoperative echocardiography, in liver transplant recipients.
We assessed 122 liver transplant recipients (94 males, 28 females; age, 50 ± 8 years). All underwent preoperative echocardiography, including measurements of heart chamber size, mass, ejection fraction, systolic pressure gradient between right ventricle and right atrium (PGsys [RV - RA]), mitral inflow velocities including early (E) and late (A) transmitral flow velocities, E/A, and deceleration time of E. Tissue Doppler imaging (TDI) was also performed to evaluate systolic (S'), early diastolic (E'), and late diastolic (A') myocardial velocities, E'/A', EAS index: E'/(A' × S'), and E/E'. Univariate and multivariate logistic regression analyses were performed to determine echocardiographic indices for predicting BNP ≥ 100 pg/mL.
Of 122 recipients, 87 (71%) had BNP < 100 pg/mL (median, 32.0 pg/mL; interquartile range [IQR], 18.0-50.0), and 35 (29%) had BNP ≥ 100 pg/mL (median, 163.0 pg/mL; IQR, 136.0-479.0). Univariate analysis showed that E (P < .001), PGsys (RV-RA) (P < .001), and E/E' (P = .038) were significantly associated with BNP ≥ 100 pg/mL. Multivariate analysis showed that PGsys (RV - RA) was the only independent predictor of BNP ≥ 100 pg/mL (odds ratio, 1.171; 95% confidence interval, 1.091-1.258; P < .001).
PGsys (RV - RA) is an echocardiographic index independently associated with BNP ≥ 100 pg/mL, suggesting that elevated BNP in patients with end-stage liver disease may reflect increased pulmonary arterial pressure, rather than systolic and diastolic dysfunction assessed by TDI.
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ABSTRACT: Cerebral blood flow and intracranial pressure (ICP) has been known to be increased after graft reperfusion during liver transplantation, which was correlated with arterial carbon dioxide concentration (PaCO2). Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is a simple and noninvasive method for evaluating ICP. We investigated the correlation between ONSD and the PaCO2 during reperfusion in liver transplant recipients. Twenty liver transplant recipients with end-stage liver disease were enrolled. We measured ONSD and PaCO2 at 6 time points: preinduction, preanhepatic phase, anhepatic phase, 5 minutes after reperfusion, 30 minutes after reperfusion, and neohepatic phase. Pearson correlation analysis and receiver operating characteristics (ROC) curve analysis were performed. ONSD measured 5 minutes after reperfusion was significantly higher compared with the other time points. Differences in ONSD between the anhepatic phase and 5 minutes after reperfusion demonstrated significant correlations with both PaCO2 at the anhepatic phase and 5 minutes after reperfusion (both P < .001). On the ROC curve analysis, PaCO2 of 35 mm Hg at the anhepatic phase could be used to indicate ≥20% changes in ONSD after reperfusion. There were significant increases in ONSD after graft reperfusion in liver transplant recipients with PaCO2 ≥ 35 mm Hg at the anhepatic phase (P = .004). ONSD was increased just after reperfusion, which demonstrated good correlation with PaCO2 during reperfusion in liver transplant recipients. This finding suggests that the carbon dioxide can play a key role in increasing ONSD during hepatic graft reperfusion.Transplantation Proceedings 07/2013; 45(6). DOI:10.1016/j.transproceed.2012.12.032 · 0.95 Impact Factor