Abstract：
BACKGROUND: Patients with cirrhosis are at risk for cardiac complications such as heart failure, particularly heart failure with preserved ejection fraction (HFpEF) due to left ventricular diastolic dysfunction (LVDD). The H2FPEF score is a predictive model used to identify patients with HFpEF. Our primary aim was to assess the H2FPEF score in patients with cirrhosis and determine its potential to identify patients at risk for heart failure after liver transplant.
METHODS: This was a cohort study of patients undergoing liver transplant for cirrhosis from January 2010 and October 2018 who had a pre-transplant transthoracic echocardiogram.
RESULTS: 166 cirrhosis subjects were included in the study. The majority were men (65%) and Caucasian (85%); NASH was the most common cause of cirrhosis (41%) followed by alcohol (34%). The median H2FPEF score was 2.0 (1.0-4.0). Patients with NASH cirrhosis had higher H2FPEF scores (3.22, 2.79-3.64) than those with alcohol induced cirrhosis (1.89, 1.5-2.29, p < 0.001) and other causes of cirrhosis (1.73, 1.28-2.18, p < 0.001). All subjects with a H2FPEF score > 6 had NASH cirrhosis. There was no association between the H2FPEF scores and measures of severity of liver disease (bilirubin, INR, or MELD score). Patients with heart failure after liver transplant had higher H2FPEF scores than those without heart failure (4.0, 3.1-4.9 vs. 2.3, 2.1-2.6, respectively; p = 0.015), but the score did not predict post-transplant mortality.
CONCLUSIONS: H2FPEF scores are higher in cirrhosis patients with NASH and appear to be associated with post-transplant heart failure, but not death.
METHODS: This was a cohort study of patients undergoing liver transplant for cirrhosis from January 2010 and October 2018 who had a pre-transplant transthoracic echocardiogram.
RESULTS: 166 cirrhosis subjects were included in the study. The majority were men (65%) and Caucasian (85%); NASH was the most common cause of cirrhosis (41%) followed by alcohol (34%). The median H2FPEF score was 2.0 (1.0-4.0). Patients with NASH cirrhosis had higher H2FPEF scores (3.22, 2.79-3.64) than those with alcohol induced cirrhosis (1.89, 1.5-2.29, p < 0.001) and other causes of cirrhosis (1.73, 1.28-2.18, p < 0.001). All subjects with a H2FPEF score > 6 had NASH cirrhosis. There was no association between the H2FPEF scores and measures of severity of liver disease (bilirubin, INR, or MELD score). Patients with heart failure after liver transplant had higher H2FPEF scores than those without heart failure (4.0, 3.1-4.9 vs. 2.3, 2.1-2.6, respectively; p = 0.015), but the score did not predict post-transplant mortality.
CONCLUSIONS: H2FPEF scores are higher in cirrhosis patients with NASH and appear to be associated with post-transplant heart failure, but not death.
摘要：
背景：肝硬化患者存在心脏并发症如心力衰竭的风险，尤其是左心室舒张功能障碍（LVDD）导致的射血分数保留（HFpEF）的心力衰竭。H2FPEF评分是用于识别HFpEF患者的预测模型。我们的主要目的是评估肝硬化患者的H2FPEF评分，并确定其识别肝移植后有心力衰竭风险的患者的潜力。
方法：这是一项2010年1月至2018年10月接受肝硬化肝移植患者的队列研究，这些患者在移植前进行了经胸超声心动图检查。
结果：166名肝硬化受试者纳入研究。大多数是男性（65％）和高加索人（85％）;NASH是肝硬化的最常见原因（41％），其次是酒精（34％）。中位H2FPEF评分为2.0(1.0-4.0)。NASH肝硬化患者的H2FPEF评分（3.22，2.79-3.64）高于酒精引起的肝硬化（1.89，1.5-2.29，p<0.001）和其他原因引起的肝硬化（1.73，1.28-2.18，p<0.001）。H2FPEF评分>6的所有受试者患有NASH肝硬化。H2FPEF评分与肝脏疾病严重程度（胆红素，INR,或MELD评分)。肝移植后心力衰竭患者的H2FPEF评分高于无心力衰竭患者（4.0、3.1-4.9vs.分别为2.3、2.1-2.6；p=0.015)，但该评分并不能预测移植后死亡率.
结论：NASH肝硬化患者的H2FPEF评分更高，并且似乎与移植后心力衰竭有关，但不是死亡。
方法：这是一项2010年1月至2018年10月接受肝硬化肝移植患者的队列研究，这些患者在移植前进行了经胸超声心动图检查。
结果：166名肝硬化受试者纳入研究。大多数是男性（65％）和高加索人（85％）;NASH是肝硬化的最常见原因（41％），其次是酒精（34％）。中位H2FPEF评分为2.0(1.0-4.0)。NASH肝硬化患者的H2FPEF评分（3.22，2.79-3.64）高于酒精引起的肝硬化（1.89，1.5-2.29，p<0.001）和其他原因引起的肝硬化（1.73，1.28-2.18，p<0.001）。H2FPEF评分>6的所有受试者患有NASH肝硬化。H2FPEF评分与肝脏疾病严重程度（胆红素，INR,或MELD评分)。肝移植后心力衰竭患者的H2FPEF评分高于无心力衰竭患者（4.0、3.1-4.9vs.分别为2.3、2.1-2.6；p=0.015)，但该评分并不能预测移植后死亡率.
结论：NASH肝硬化患者的H2FPEF评分更高，并且似乎与移植后心力衰竭有关，但不是死亡。
