大葉大學圖書館 |

The Association Between Left Atrial Volume Index and Liver Transplant Survival.

紀錄類型:	書目-電子資源 : Monograph/item
書名/作者:	The Association Between Left Atrial Volume Index and Liver Transplant Survival.
作者:	Ershoff, Brent David.
出版者:	Ann Arbor : : ProQuest Dissertations & Theses, , 2016
面頁冊數:	47 p.
附註:	Source: Masters Abstracts International, Volume: 55-05.
Contained By:	Masters Abstracts International55-05(E).
標題:	Medicine.
ISBN:	9781339848860
摘要、提要註:	Background: Cardiac complications are the leading cause of long-term non-graft related mortality following liver transplantation. While the Scientific Registry of Transplant Recipients (SRTR) reports multiple risk factors for post-operative mortality, there are currently no cardiac specific risk factors included in the survival models. Cirrhotic cardiomyopathy, a spectrum of cardiovascular changes associated with end stage liver disease including diastolic dysfunction (DD), is well described. Left atrial volume index (LAVI) is an echocardiographic measure of DD, and has been associated with mortality in many populations. Unlike transmitral inflow velocities which are load dependent, LAVI is considered to be a more sensitive and stable measurement of DD. To date, there is limited data evaluating the effect of LAVI on mortality following liver transplantation. The aims of this study were to determine whether LAVI is an independent predictor of post-liver transplant mortality, and whether LAVI improves the ability to predict mortality beyond known risk factors.

The Association Between Left Atrial Volume Index and Liver Transplant Survival.
Ershoff, Brent David.

The Association Between Left Atrial Volume Index and Liver Transplant Survival. - Ann Arbor : ProQuest Dissertations & Theses, 2016 - 47 p.

Source: Masters Abstracts International, Volume: 55-05.

Thesis (M.S.)--University of California, Los Angeles, 2016.

Background: Cardiac complications are the leading cause of long-term non-graft related mortality following liver transplantation. While the Scientific Registry of Transplant Recipients (SRTR) reports multiple risk factors for post-operative mortality, there are currently no cardiac specific risk factors included in the survival models. Cirrhotic cardiomyopathy, a spectrum of cardiovascular changes associated with end stage liver disease including diastolic dysfunction (DD), is well described. Left atrial volume index (LAVI) is an echocardiographic measure of DD, and has been associated with mortality in many populations. Unlike transmitral inflow velocities which are load dependent, LAVI is considered to be a more sensitive and stable measurement of DD. To date, there is limited data evaluating the effect of LAVI on mortality following liver transplantation. The aims of this study were to determine whether LAVI is an independent predictor of post-liver transplant mortality, and whether LAVI improves the ability to predict mortality beyond known risk factors.

ISBN: 9781339848860Subjects--Topical Terms:

373206
Medicine.

The Association Between Left Atrial Volume Index and Liver Transplant Survival.
LDR:04459nmm a2200301 4500 001 476222
005 20170614101406.5
008 181208s2016 ||||||||||||||||| ||eng d
020 $a 9781339848860
035 $a (MiAaPQ)AAI10126848
035 $a AAI10126848
040 $a MiAaPQ $c MiAaPQ
100 1 $a Ershoff, Brent David. $3 686791
245 1 4 $a The Association Between Left Atrial Volume Index and Liver Transplant Survival.
260 1 $a Ann Arbor : $b ProQuest Dissertations & Theses, $c 2016
300 $a 47 p.
500 $a Source: Masters Abstracts International, Volume: 55-05.
500 $a Advisers: Christopher Wray; Robert M. Elashoff.
502 $a Thesis (M.S.)--University of California, Los Angeles, 2016.
520 $a Background: Cardiac complications are the leading cause of long-term non-graft related mortality following liver transplantation. While the Scientific Registry of Transplant Recipients (SRTR) reports multiple risk factors for post-operative mortality, there are currently no cardiac specific risk factors included in the survival models. Cirrhotic cardiomyopathy, a spectrum of cardiovascular changes associated with end stage liver disease including diastolic dysfunction (DD), is well described. Left atrial volume index (LAVI) is an echocardiographic measure of DD, and has been associated with mortality in many populations. Unlike transmitral inflow velocities which are load dependent, LAVI is considered to be a more sensitive and stable measurement of DD. To date, there is limited data evaluating the effect of LAVI on mortality following liver transplantation. The aims of this study were to determine whether LAVI is an independent predictor of post-liver transplant mortality, and whether LAVI improves the ability to predict mortality beyond known risk factors.
520 $a Methods: We performed a retrospective cohort study of patients ≥ 18 years of age who underwent liver transplantation between July 2011 and June 2014 at the University of California, Los Angeles, and who had their preoperative transthoracic echocardiograms performed at our center. The primary outcome was time to mortality, and the primary predictor was LAVI, dichotomized at 28ml/m2. Known risk factors of post liver transplant mortality identified from the SRTR database were collected as covariates. A multivariable Cox regression model was built using a backwards stepwise selection procedure to assess the effect of LAVI on post-operative mortality.
520 $a Results: Of the 254 patients included in our analysis, 48 deaths occurred over the follow-up period (median: 17.5 months). In a multivariable model including re-transplantation, physiologic MELD score (dichotomized at the sample median of 33), preoperative mechanical ventilation, previous malignancy, and HCV, LAVI was not a statistically significant predictor of mortality (HR: 0.99, p=0.99, 95% CI: 0.56, 1.77). Given that advanced liver disease is associated with cirrhotic cardiomyopathy, we explored whether the effect of LAVI on mortality differed as a function of MELD score. In a multivariable model including the covariates listed above, there was a statistically significant interaction between LAVI and MELD score (p=0.007). Specifically, for patients with MELD scores ≥ 33, LAVI ≥ 28 ml/m2 was associated with increased mortality (HR=2.4, p=0.032, 95% CI 1.1, 5.4). However, for patients with MELD scores < 33, LAVI was not associated with mortality (HR: 0.44, p=0.08, 95% CI 0.18, 1.1). The C-statistic for the model including LAVI and the interaction was 0.73, statistically significantly greater than the C-statistic of 0.67 for the model excluding these terms, thus demonstrating an improvement in the predictive ability of that model.
520 $a Discussion: This is the first study to examine the effect of LAVI as a predictor of post-liver transplant mortality using a multivariable model. We demonstrated that LAVI had a significant impact on mortality among patients with high MELD scores, whereas this effect was not observed among patients with lower MELD scores. Liver transplant recipients with high LAVI values and high MELD scores may represent patients with advanced cirrhotic cardiomyopathy who may be at an increased risk of postoperative mortality. This may have important consequences for the selection of liver transplant recipients.
590 $a School code: 0031.
650 4 $a Medicine. $3 373206
690 $a 0564
710 2 0 $a University of California, Los Angeles. $b Clinical Research. $3 629872
773 0 $t Masters Abstracts International $g 55-05(E).
790 $a 0031
791 $a M.S.
792 $a 2016
793 $a English