Preoperative echocardiographic indices associated with elevated brain natriuretic peptide in liver transplant recipients

Background

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.

Methods

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.

Results

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).

Conclusion

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.