Editorial
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 14, 2008; 14(22): 3445-3451
Published online Jun 14, 2008. doi: 10.3748/wjg.14.3445
Cardiac evaluation of liver transplant candidates
Mercedes Susan Mandell, JoAnn Lindenfeld, Mei-Yung Tsou, Michael Zimmerman
Mercedes Susan Mandell, Department of Anesthesiology, University of Colorado Health Sciences Center, Aurora, Colorado 80045, United States
JoAnn Lindenfeld, Department of Cardiology, University of Colorado Health Sciences Center, Aurora, Colorado 80045, United States
Mei-Yung Tsou, Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
Michael Zimmerman, Department of Surgery, University of Colorado Health Sciences Center, Aurora, Colorado 80045, United States
Author contributions: Mandell MS, Lindenfeld J, Tsou MY, Zimmerman M contributed equally to this paper.
Correspondence to: Mercedes Susan Mandell, MD, PhD, University of Colorado Health Sciences Center, Leprino Building 7th Floor, 12401 East 17th Ave B113, Aurora, Colorado 80045, United States. susan.mandell@uchsc.edu
Telephone: +1-720-8486709
Fax: +1-720-8487375
Received: March 7, 2008
Revised: April 8, 2008
Accepted: April 15, 2008
Published online: June 14, 2008
Abstract

Physicians previously thought that heart disease was rare in patients with end stage liver disease. However, recent evidence shows that the prevalence of ischemic heart disease and cardiomyopathy is increased in transplant candidates compared to most other surgical candidates. Investigators estimate that up to 26% of all liver transplant candidates have at least one critical coronary artery stenosis and that at least half of these patients will die perioperatively of cardiac complications. Cardiomyopathy also occurs in greater frequency. While all patients with advanced cardiac disease have defects in cardiac performance, a larger than expected number of patients have classical findings of dilated, restrictive and hypertrophic cardiomyopathy. This may explain why up to 56% of patients suffer from hypoxemia due to pulmonary edema following transplant surgery. There is considerable controversy on how to screen transplant candidates for the presence of heart disease. Questions focus upon, which patients should be screened and what tests should be used. This review examines screening strategies for transplant candidates and details the prognostic value of common tests used to identify ischemic heart disease. We also review the physiological consequences of cardiomyopathy in transplant candidates and explore the specific syndrome of “cirrhotic cardiomyopathy”.

Keywords: Coronary artery disease; Coronary atherosclerosis; Echocardiography; Cirrhosis; Cardiomyopathy; Cardiac electrophysiology liver transplantation