Measures of Right Ventricular Systolic Function in End Stage Liver Disease Patients Awaiting Transplant

Quantification of right ventricular (RV) systolic function has become increasingly important, as detection of subclinical RV dysfunction has been clearly correlated with adverse clinical outcomes in a significant number of clinical scenarios [ 1 Haddad F. Doyle R. Murphy D.J. Hunt S.A. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008; 117: 1717-1731 Crossref PubMed Scopus (1011) Google Scholar , 2 Voelkel N.F. Quaife R.A. Leinwand L.A. et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006; 114: 1883-1891 Crossref PubMed Scopus (998) Google Scholar , 3 Rudski L.G. Lai W.W. Afilalo J. et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23: 685-713 Abstract Full Text Full Text PDF PubMed Scopus (5237) Google Scholar , 4 Matthews J.C. Dardas T.F. Dorsch M.P. Aaronson K.D. Right-sided heart failure: diagnosis and treatment strategies. Curr Treat Options Cardiovasc Med. 2008; 10: 329-341 Crossref PubMed Google Scholar ]. Despite the wide use of echocardiography among patients with end stage liver disease (ESLD) being considered for orthotropic liver transplantation (OLT), echocardiographic data has been mainly limited to assessment of porto-pulmonary hypertension [ [5] Torregrosa M. Aguadé S. Dos L. et al. Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates. J Hepatol. 2005; 42: 68-74 Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar ], determination of intrapulmonary shunts [ [6] Sussman N.L. Kochar R. Fallon M.B. Pulmonary complications in cirrhosis. Curr Opin Organ Transplant. 2011 Jun; 16: 281-288 Crossref PubMed Scopus (19) Google Scholar ] or evaluation of wall motion abnormalities during the infusion of dobutamine [ [7] Harinstein M.E. Flaherty J.D. Ansari A.H. et al. Predictive value of dobutamine stress echocardiography for coronary artery disease detection in liver transplant candidates. Am J Transplant. 2008; 8: 1523-1528 Crossref PubMed Scopus (112) Google Scholar ]. However, it is unclear what constitutes a normal range of values to describe RV systolic function in this patient population; particularly when ESLD patients are known to have a hyperdynamic circulatory state [ [8] Siniscalchi A. Aurini L. Spedicato S. et al. Hyperdynamic circulation in cirrhosis: predictive factors and outcome following liver transplantation. Minerva Anestesiol. 2013; 79: 15-23 PubMed Google Scholar ].