Browsing by Author "Zenisek, Joseph"

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    Hepatic Ischemia/Reperfusion Injury After Liver Transplantation Is Not Associated with Early Impairment of Left Ventricular Ejection Fraction
    (International Scientific Information, 2022-12-13) Rokop, Zachary P.; Frick, Kyle; Zenisek, Joseph; Kroepfl, Elizabeth; Mihaylov, Plamen; Patidar, Kavish R.; Nephew, Lauren; Mangus, Richard S.; Kubal, Chandrashekhar; Surgery, School of Medicine
    Background: Early myocardial dysfunction is a known complication following liver transplant. Although hepatic ischemia/reperfusion injury (hIRI) has been shown to cause myocardial injury in rat and porcine models, the clinical association between hIRI and early myocardial dysfunction in humans has not yet been established. We sought to define this relationship through cardiac evaluation via transthoracic echocardiography (TTE) on postoperative day (POD) 1 in adult liver transplant recipients. Material/Methods: TTE was performed on POD1 in all liver transplant patients transplanted between January 2020 and April 2021. Hepatic IRI was stratified by serum AST levels on POD1 (none: <200; mild: 200–2000; moderate: 2000–5000; severe: >5000). All patients had pre-transplant TTE as part of the transplant evaluation. Results: A total of 173 patients underwent liver transplant (LT) between 2020 and 2021 and had a TTE on POD 1 (median time to echo: 1 day). hIRI was present in 142 (82%) patients (69% mild, 8.6% moderate, 4% severe). Paired analysis between pre-LT and post-LT left ventricular ejection fraction (LVEF) of the entire study population demonstrated no significant decrease following LT (mean difference: −1.376%, P=0.08). There were no significant differences in post-LT LVEF when patients were stratified by severity of hIRI. Three patients (1.7%) had significant post-transplant impairment of LVEF (<35%). None of these patients had significant hIRI. Conclusions: hIRI after liver transplantation is not associated with immediate reduction in LVEF. The pathophysiology of post-LT cardiomyopathy may be driven by extra-hepatic triggers.
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    Prognosis of Patients with Advanced Liver Disease and Positive Stress Echocardiograms: Impact of Coronary Artery Disease, Non-alcoholic Steatohepatitis, and Beta-blocker Therapy
    (Scientific Archives, 2022) Nazif, Kutaiba; Mastouri, Ronald; Zenisek, Joseph; Green-Hess, Deborah; Ghabril, Marwan; Feigenbaum, Harvey; Sawada, Stephen G.; Medicine, School of Medicine
    Background: In the general population, a positive dobutamine stress echocardiogram (DSE) in the absence of obstructive coronary artery disease (CAD) still identifies a high risk group. DSE is a widely employed screening method in candidates for liver transplantation. We investigated the prognostic impact of a positive DSE, CAD, and clinical factors in advanced liver disease. Methods: We obtained follow-up for cardiovascular events (angina requiring revascularization, heart failure, infarction, and cardiac death) in 61 liver transplant candidates who had positive DSE and coronary angiography. Event-free survival was compared between 22 patients with obstructive CAD (≥ 70% stenosis) and 39 patients with no obstructive CAD. Cox regression was used to identify factors associated with events. Results: Over a mean follow-up of 27 ± 28 months, 21% (8/39) of patients with positive DSE and no CAD had events compared with 45% (10/22) of patients with positive DSE and CAD (p = 0.04). Event free survival was better in those without CAD (p = 0.014) but one year cardiac mortality was similar in those with (9%) and without CAD (8%). Multivariable analysis showed that beta blocker use (HR: 4.1, 95% CI: 1.7 – 9.9, p-value = 0.010), CAD (HR: 4.4 95% CI: 1.8– 10.8, p-value = 0.008), and non-alcoholic steatohepatitis (NASH) (HR: 4.9, 95% CI: 2.0 – 11.7, p-value = 0.04) were independently associated with events. Conclusion: Advanced liver disease patients with positive DSE are at increased risk. CAD, beta blocker use and NASH are independently associated with cardiac events.