Abstract：
UNASSIGNED: Liver transplantation (LT) is a strenuous event for the cardiovascular system. Cardiovascular events (CVE), including heart failure (HF), arrhythmias and myocardial ischemia, are important causes of peri- and post-liver transplantation morbidity and mortality.
UNASSIGNED: We describe the case of a 45-year-old male patient who developed heart failure with severely reduced ejection fraction (HFrEF) after receiving liver transplantation (LT) for end-stage post-alcoholic liver cirrhosis. Preoperative transthoracic echocardiography (TTE) demonstrated borderline left ventricular ejection fraction (LVEF) of 50% and diastolic dysfunction grade 2. On coronary angiography, the patient had no coronary stenoses. Persistent vasopressor need, increasing creatinine levels and progressive pleural effusion characterized the early postoperative period. TTE on postoperative day 6 revealed a new finding of a markedly reduced LVEF of 15%, accompanied by a discrete increase in hs-TnI and CK-MB without electrocardiographic (ECG) ST-T abnormalities. LVEF did not recover completely (EF 45%) during follow-up. The patient had a sudden death 4.5 months post-liver transplantation.
UNASSIGNED: Our case demonstrates that the risk of post-LT systolic dysfunction is not excluded by preoperative resting examinations within normal range and highlights the need for preoperative cardiac stress assessment (e.g. dobutamine echocardiography or stress cardiac magnetic resonance imaging) before LT. In addition, patients on a liver-transplant waiting list with cardiac dysfunction should be followed by a multidisciplinary team including a dedicated cardiology team experienced in managing liver-related cardiac pathology.
UNASSIGNED: We describe the case of a 45-year-old male patient who developed heart failure with severely reduced ejection fraction (HFrEF) after receiving liver transplantation (LT) for end-stage post-alcoholic liver cirrhosis. Preoperative transthoracic echocardiography (TTE) demonstrated borderline left ventricular ejection fraction (LVEF) of 50% and diastolic dysfunction grade 2. On coronary angiography, the patient had no coronary stenoses. Persistent vasopressor need, increasing creatinine levels and progressive pleural effusion characterized the early postoperative period. TTE on postoperative day 6 revealed a new finding of a markedly reduced LVEF of 15%, accompanied by a discrete increase in hs-TnI and CK-MB without electrocardiographic (ECG) ST-T abnormalities. LVEF did not recover completely (EF 45%) during follow-up. The patient had a sudden death 4.5 months post-liver transplantation.
UNASSIGNED: Our case demonstrates that the risk of post-LT systolic dysfunction is not excluded by preoperative resting examinations within normal range and highlights the need for preoperative cardiac stress assessment (e.g. dobutamine echocardiography or stress cardiac magnetic resonance imaging) before LT. In addition, patients on a liver-transplant waiting list with cardiac dysfunction should be followed by a multidisciplinary team including a dedicated cardiology team experienced in managing liver-related cardiac pathology.
摘要：
■肝移植（LT）是心血管系统的一项艰苦事件。心血管事件（CVE），包括心力衰竭(HF),心律失常和心肌缺血,是肝移植前后发病率和死亡率的重要原因。
■我们描述了一例45岁男性患者在接受终末期酒精性肝硬化肝移植（LT）后出现心力衰竭，射血分数（HFrEF）严重降低的病例。术前经胸超声心动图（TTE）显示临界左心室射血分数（LVEF）为50％，舒张功能障碍为2级。在冠状动脉造影中，患者没有冠状动脉狭窄。持续的血管加压药需要，肌酐水平升高和进行性胸腔积液是术后早期的特征。术后第6天的TTE显示了一个新的发现，即LVEF显着降低了15％，伴随着hs-TnI和CK-MB的离散增加，而没有心电图（ECG）ST-T异常。随访期间LVEF未完全恢复（EF45%）。患者在肝移植后4.5个月突然死亡。
■我们的案例表明，在正常范围内的术前静息检查并未排除LT后收缩功能障碍的风险，并强调需要在LT前进行术前心脏负荷评估（例如多巴酚丁胺超声心动图或负荷心脏磁共振成像）。此外,在有心脏功能障碍的肝移植等待名单上的患者应该由多学科团队随访,包括在管理肝脏相关心脏病理方面有经验的专门心脏病学团队.
■我们描述了一例45岁男性患者在接受终末期酒精性肝硬化肝移植（LT）后出现心力衰竭，射血分数（HFrEF）严重降低的病例。术前经胸超声心动图（TTE）显示临界左心室射血分数（LVEF）为50％，舒张功能障碍为2级。在冠状动脉造影中，患者没有冠状动脉狭窄。持续的血管加压药需要，肌酐水平升高和进行性胸腔积液是术后早期的特征。术后第6天的TTE显示了一个新的发现，即LVEF显着降低了15％，伴随着hs-TnI和CK-MB的离散增加，而没有心电图（ECG）ST-T异常。随访期间LVEF未完全恢复（EF45%）。患者在肝移植后4.5个月突然死亡。
■我们的案例表明，在正常范围内的术前静息检查并未排除LT后收缩功能障碍的风险，并强调需要在LT前进行术前心脏负荷评估（例如多巴酚丁胺超声心动图或负荷心脏磁共振成像）。此外,在有心脏功能障碍的肝移植等待名单上的患者应该由多学科团队随访,包括在管理肝脏相关心脏病理方面有经验的专门心脏病学团队.
