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acute coronar y syndrome. However, this study was again limited in size and focused predominantly on athero-

sclerotic complications and thus has limited generalizability. A large multicenter study by VanWagner et al.

(n 5 54,697) created the first prognostic model for predicting early (30-day) postoperative CVD mortality after LT

among patients who received a LT in the US between 2002 and 2011

[3]. This study identified significant predic-

tors of early postoperative CVD mortality including age, hospitalization status, intensive care unit status, respira-

tory failure on a ventilator, MELD score, history of portal vein thrombosis, donor BMI, cold ischemia time, and

national organ sharing. Although the risk model had better discriminative ability (C statistic 5 0.66) than other

pretransplant risk indices (i.e., MELD, CTP) for cardiac outcomes, specifically the moderate c-statistic limits its

clinical use.

This same group conducted a retrospective cohort study of 32,810 LT recipients with the objective of identify-

ing factors associated with hospitalization for MACE, defined as MI, AF, PE, HF, cardiac arrest, and stroke, after

[4]. This was the first multicenter assessment of MACE hospitalization after LT in a national sample and cap-

tured 60% of the LT population in the US. In this study, the most common cause of MACE with in 90 days of LT

was AF (43%), HF (24%), and PE (11%). This again highlights the observation that most early cardiac events after

LT are noncoronary in nature. Multivariate analysis found that age . 65, alcoholic cirrhosis, NASH, pretrans-

plant creatinine, AF, and stroke were significantly associated with early MACE after LT. Early MACE was associ-

ated with lower 1-year survival, higher rates of cardiovascular-related mortality, and greater long-term mortality

compared to participants without an early MACE. This study found that pretransplant AF and stroke, in particu-

lar, significant ly increased the risk of MACE (Incidence rate ratio 5 6.9 and 6.3 for AF and stroke, respectively)

demonstrating the need for future studies addressing risk factor reduction to see if those measures could reduce

post-LT outcomes.

Given the limitations of prior studies to predict CVD complications after LT, VanWagner et al. developed a

point-based prediction model for CVD complications after LT: the Cardiovascular Risk in Orthotopic LT risk

score(CAR-OLT,availableat:

http://www.carolt.us) [115]. CVD complications were defined as death from a

CVD cause or hospitalization due to a major CVD event (MI, revascu larization , HF, AF, cardiac arrest, PE, tran-

sient ischemic attack/stroke). The goal of this study was to create a risk score t o estimate the risk of intraopera-

tive and early postoperative and late postoperative CVD related morbidity and mortality. This score predicts

the 1-year risk of death or hospitalization related to major CVD events based on pretransplant variables that

can easily be obtained at the point of care. Pretransplant factors included in CAR-OLT are age, sex, race, educa-

tion, employment status, history of AF, pulmonary hypertension, systemic hypertension, diabetes, HF, pres-

ence of hepatocellular carcinoma (HCC), and ventilator dependence at time of LT. HCC status and

employment status, a surrogate marker for functional status, were novel markers for improved CVD morbidity

and mortality after LT.

CAR-OLT scores correlate with risk for a 1-year CVD event ranging to , 5% to . 45% and can be used to

guide risk discussions with patients to determine if further preoperative testing is indicated beyond what current

guidelines dictate or if targeted risk factor reduction could improve CVD outcomes

[5,115]. This tool can also be

used to identify patients at higher long-term risk of CVD related morbidity and mortality who may require closer

postoperative monitoring and management to avoid the occurrence of a CVD event. Additionally, identifying a

patient to be at significantly high risk of a CVD event may warrant a discussion of whether it is appropriate to

allocate a scarce organ to such a patient thoug h future validation of CAR-OLT is needed to understand the full

impact of these risk discussions.

Strengths of this study include the large sample size (n 5 1024), use of multiple recipient, operative, and

donor related factors (300 1 ) and advanced statistical modeling to determine the most parsimonious model.

This model had good discriminative ability (C statistic 5 0.78 after internal validation using bootstrapping

techniques) to predict CVD complications at 1-year post-LT. Additionally, this study found event rates similar

to prior studies demonstrating its generalizability. This study has several limitations as it was conducted at a

single academic medical center and needs to be validated prospectively and in other populations. A dditionally,

this score is only able to predict CVD risk until 1 year after LT and is not able to comment on longer term car-

diovascular survival.

Two additional disease-specific clinical risk scores have been published in the last five years for CV risk pre-

diction in LT candidates. The “Cardiac Arrest Risk Index” (CARI) is point-based model for predicting cardiac

arrest and ventricular arrhythmias within 30-days of LT (optimism-corrected C-statistic, 0.77)

[27]. The “CAD in

LTx” (CAD-LT) score (available at

http://www.cad-lt.com) predicts significant (e.g., obstructive) coronary heart

disease (internal cross-validation C-statistic, 0.76)

[116].

344 20. Predicting cardiovascular complications after liver transplantation

III. Cardiovascular system in liver failure

https://t.me/medicina_free

Conclusions

In summary, accurate CVD risk prediction in the complex LT population is vitally important for several rea-

sons. CVD is a major cause of morbidity and mortality after LT and is the leading cause of nongraft related death

after LT. CVD outcomes are affected by both LT specific risk factors as well as traditional CVD risk factors.

Because the current system of liver allocation is based on MELD scores, liver transplants are being prioritized to

the sickest patients with a high burden of critical illness who have an increased risk of both clinical and subclini-

cal CVD. CVD comorbid conditions, such as metabolic syndrome, are becoming increasingly common amongst

LT candidates both in the pre and post-transplant setting. Furthermore, several cardiac complications can arise in

the perioperative, early postoperative, and late postoperative time points of LT that can be life threatening.

Thus tools that enable dynamic risk strat ification in order to identify high risk patients for CVD are needed in

order to predict both perioperative and longterm adverse CV events after LT. Liver grafts are a scarce resource,

and the goal should be to maximize the bene fit of the organ by reducing morbidity and mortality of the recipi-

ents. Until the development of the CAR-OLT score, a LT specific global CVD risk calculator did not exi st.

Although CAR-OLT is able to predict the 1-year risk of death or hospitalization due to CVD with good discrimi-

native ability, it requires prospective validation and additional study in order to assess its impact on long-term

cardiovascular survival. The CARI score and CAD-LT score can be used to specifically predict cardiac arrest and

CHD risk, respectively. Other surgical and cardiovascular risk models including the RCRI, FRS, and PCE may be

able to be calibrated to better predict CVD risk in LT recipients. Based on risk stratification using these models,

perioperative work up and intraoperative and postoperative management could be adjusted to minimize the

development of CVD, decrease mortality, and improve overall survival after LT.

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348 20. Predicting cardiovascular complications after liver transplantation

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Index

Note: Page numbers followed by “f” and “t” refer to figures and tables, respectively

AASLD. See American Association for Study

of Liver Diseases (AASLD)

ABCA1. See ATP-binding cassette protein A1

(ABCA1)

Abdominal CT/MRI scan, 141

Abdominal obesity, 337

Abnormal LFT

anatomy of hepatic lobule, 107f

association between hemodynamics and,

107108

pathophysiology of abnormal LFT in heart

failure, 106107

Abnormal liver chemistry in acute

decompensated HF, prevalence and

prognostic relevance of, 117118

Abnormal liver function in chronic

HF, 117

Abnormal liver synthetic function and heart

failure, 118

ACC. See American College of Cardiology

(ACC)

ACCF. See American College of Cardiology

Foundation (ACCF)

ACE. See Angiotensin-converting enzyme

(ACE)

Acetaminophen, 36

Acinetobacter baumannii, 160

ACS NSQIP. See American College of

Surgeons National Surgical Quality

Improvement Program (ACS NSQIP)

Activated partial thromboplastin time

(APTT), 169

Acute cardiogenic liver injury (ACLI), 98

Acute coronary syndrome (ACS), 300301.

See also Sinusoidal obstruction

syndrome (SOS)

Acute decompensated HF, prevalence and

prognostic relevance of abnormal liver

chemistry in, 117118

Acute hepatocellular injury, 110

Acute hypoperfusion, 116

Acute kidney injury (AKI), 275

definition and diagnostic criteria of,

277278

HRS-AKI, 277t

Acute liver failure (ALF), 172, 177178

cardiovascular consequences of, 261262

implications for intensive care

management and liver

transplantation, 261262

Acute lung injury (ALI), 304

Acute respiratory distress syndrome (ARDS),

303304

Acute study of clinical effectiveness of

nesiritide in decompensated HF

(ASCEND-HF), 97

Acute tubular necrosis (ATN), 275

Acute-on-chronic liver failure (ACLF),

154155, 176177, 284286

CLIF Consortium, 155t

CLIF-C organ failure scoring system, 154t

immunosuppression in cirrhosis and,

156

157

infection-related acute-on-chronic liver

failure vs. acute-on-chronic liver

failure unrelated to infection, 155

inflammatory phenotype of sepsis in,

154157

pathophysiology of infection-related acute-

on-chronic liver failure, 155156

unrelated to infection

Acute-on-chronic renal failure, 275

Acute-phase proteins, 150

synthesis during infection, 149151, 151t

Acutely decompensated heart failure

(ADHF), 117

Adrenal insufficiency, 225

AF. See Atrial dysrhythmia (AF); Atrial

fibrillation (AF)

Air embolism, 331

AKI. See Acute kidney injury (AKI)

Alagille syndrome (ALGS), 248249

congenital cardiovascular defects

associated with, 248249

peripheral vascular defects in, 249

Alanine aminotransferase (ALT), 96, 105

Alanine transaminase (ALT), 34, 117

Albumin, 82, 105, 111, 160, 238, 283

β blockers in patients with CCM, 236t

liver transplantation in patients with

cardiac dysfunction, 234t

Alcohol, 41, 211212

alcohol-associated cirrhosis, 311, 317

Alcoholic cardiomyopathy, 217218

Alcoholic liver disorder, 11

Alcoholic steatohepatitis, 42

Aldosterone antagonists, 241

ALF. See Acute liver failure (ALF)

ALI. See Acute lung injury (ALI)

Alkaline phosphatase (ALP), 96, 105, 110,

117

Alpha-1 antitrypsin deficiency, 303

Alpha-1-antagonism, 52

Alpha-tocopherol, 47

α-1-adrenergic antagonist activity, 52

α1-acid glycoprotein, 26

Alternative monitoring strategies, 183

Amebiasis, 100

American Association for Study of Liver

Diseases (AASLD), 98

American College of Cardiology (ACC), 338

American College of Cardiology Foundation

(ACCF), 310

American College of Surgeons National

Surgical Quality Improvement

Program (ACS NSQIP), 342

American Heart Association (AHA), 310, 338

American Society of Anesthesiologists

(ASA), 170

American Society of Echocardiography

(ASE), 221, 319320

Amino acids, 152153

Amiodarone, 3149

amiodarone-liver injury, 42

determinant of drug exposure, 3435

drug outside comfort zone of mainstream

therapeutics, 3940

effects on hepatic metabolism and drugs,

pharmacodynamic drugdrug

interactions with, 45t

pharmacokinetic drugdrug

interactions with, 45t

hepatotoxicity

amiodarone steatohepatitis, 42f

challenge of attribution, 45

clinical picture and histological findings,

4142

diagnosis, 4243

microvesicular steatosis, 41f

plausible pathogenesis, 40

historical perspective, 32

lessons from pulmonary toxicity

considering hepatotoxicity, 3739

monitoring hepatic function in patients

receiving amiodarone, 4647

principles of clinical pharmacology, 4748

replacement, 3233

pharmacokinetics of, 33f

separating direct and indirect toxicity,

3637

serum ALT, 37f

therapy for hepatotoxicity, 47

timelines for amiodarone hepatotoxicity,

349

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Amiodarone (Continued)

toxic amiodarone to liver, 4344

understanding amiodarone, 34

untenable concept of total cumulative dose

of, 3536

Anemia, 17

Angiotensin-converting enzyme (ACE),

1718, 98

Anhepatic phase, 299300

Animal models, 40

historic evidences of pathologic bile acid-

myocardial interaction in, 256257

ANP. See Atrial natriuretic peptide (ANP)

Antibiotic therapy, 287

Anticoagulant therapy, 7273

Antifibrinolytic therapy, 182

Antithrombin deficiencies, 67

Aortic sclerosis, 12

Aortic stenosis (AS), 294

Apoptotic bodies, 133134

APTT. See Activated partial thromboplastin

time (APTT)

ARDS. See Acute respiratory distress

syndrome (ARDS)

Arrhythmias, 12

Arterial thrombosis

incidence and pathogenesis, 185

prevention, 186

treatment, 187

Arterial vascular tone

abnormalities of, 209211

inflammation, 210211

vasoactive molecules, 209210

Arterial vasodilatation hypothesis, 211

Arterio-hepatic dysplasia, 249

AS. See Aortic stenosis (AS)

ASA. See American Society of

Anesthesiologists (ASA)

ASCEND-HF. See Acute study of clinical

effectiveness of nesiritide in

decompensated HF (ASCEND-HF)

Ascites, 285

ASE. See American Society of

Echocardiography (ASE)

Aspartate aminotransferase (AST), 96, 105

Aspartate transaminase, 117

Atherosclerosis, molecular mechanisms

between nonalcoholic steatohepatitis

and, 1314

Atherosclerotic cardiovascular disease

(ASCVD), 339

ATN. See Acute tubular necrosis (ATN)

ATP-binding cassette protein A1 (ABCA1),

ATP7B gene, 260

Atrial dysrhythmia (AF), 316319

diagnosis and treatment of atrial

fibrillation in LT candidates, 318319

prevalence and risk factors of atrial

fibrillation in LT candidates, 316318

Atrial fibrillation (AF), 295, 312, 327

Atrial natriuretic peptide (ANP), 264265

Autoimmune diseases, 100, 136

Autonomic dysfunction, 211

Autonomic nervous system, 211

BA. See Biliary atresia (BA)

Bacteria, 145

Bacterial infections, 157, 204205, 287

prevention of, 162

Bacterial translocation, 204205

Baltimore criteria, 78

BASM. See Biliary Atresia Splenic

Malformation (BASM)

BCS. See BuddChiari syndrome (BCS)

Bernoulli equation, 268

Beta-blockers, 4955, 126, 315

in acute on chronic liver failure, 55

clinical contexts for use of nonselective

beta-blockers, 5255

baseline risk, 54t

beta-blockers and prevention of first

bleeding, 54f

clinical pharmacology of nonselective beta-

blockers in portal hypertension

related to cirrhosis, 4952

pathophysiology of portal hypertension

and cirrhosis stages, 49

for portal hypertensive gastropathy, 55

therapeutic window of nonselective beta-

blockers in decompensated cirrhosis,

5557

therapy, 44, 312

Beta-receptor-blocking agents, 3132

β-adrenergic receptor blockers (β-blockers),

231233

CCM in systolic and diastolic function

after liver transplantation, 233t

β-adrenergic signalling, 227

Bile acids, 148149, 208, 228, 256

bile acid-myocardial interaction

in animal models, historic evidences of

pathologic, 256257

clinical evidence of pathologic, 256

mechanistic insights into, 257258

as potential mechanism of

cardiomyopathy, 255256

heart as target for, 256

induce metabolic disturbance in heart,

257258

Bile salt export pump (BSEP), 148

Biliary atresia (BA), 223

Biliary Atresia Splenic Malformation

(BASM), 248249

Bilirubin, 96, 117

metabolism in liver, 107, 108f

Biochemical cholestatic pattern, 9596

Biomarkers, 281282

Bleeding

complications, 180

disorders, 178

in liver diseases, 178183

incidence and pathogenesis, 180

prevention, 180182

treatment, 182183

Blood

circulation, 3, 4f,56, 203

clearance, 2324

European society for blood

transplantation, 7980

flow, 105

supply of liver and anatomy, 105106

volume/decreased effective circulating

volume, 209

Blood pressure (BP), 231, 336

BMI. See Body mass index (BMI)

Body mass index (BMI), 1213, 97, 311, 329

Bradyarrhythmias, 295296

Brain natriuretic peptide (BNP), 116,

252254, 340

Brain NOS (bNOS), 206

BuddChiari syndrome (BCS), 65, 69t

Bumetanide, 26

Bypassing agents, 178

c-fos

c-fos-dependent pathway, 208

c-fos-mediated pathway, 208

gene, 208

C-type lectin receptors, 145

Cachexia, 17

CACS. See Coronary artery calcium score

(CACS)

CAD. See Coronary artery disease (CAD)

Calcineurin inhibitors (CNIs), 335336

Calcitonin gene-related peptides (CGRP),

209210

Canadian Amiodarone Myocardial Infarction

Arrhythmia Trial (CAMIAT), 37

Canakinumab Antiinflammatory Thrombosis

Outcome Study (CANTOS), 12

Cannabinoid receptor type 1 (CB1), 207

Cannabis sativa, 207

Capsaicin, 208

CAPV. See Congenital absence of portal vein

(CAPV)

Carbon monoxide (CO), 205207, 227, 229

Carboxypeptidase cathepsin A transgenic

(CatA-TG), 230

Cardiac abnormalities, 217218

Cardiac arrest and arrhythmia, 330331, 333

causes of death for patients, 331t

Cardiac Arrest Risk Index (CARI), 344

Cardiac Arrhythmia Suppression Trial

(CAST), 32

Cardiac arrhythmias, 302

Cardiac biomarkers in plasma/sera, 264265

Cardiac catheterization, 268269

Cardiac cirrhosis, 98, 117, 125, 136

Cardiac dysfunction, 205, 217

association between NAFLD, 14

in cirrhosis, 279

Cardiac dysrhythmias, 295

assessment of, 316319

atrial dysrhythmia, 316319

ventricular arrhythmias, 319

Cardiac endocannabinoids, 230

Cardiac function, 224226, 331332

Cardiac hepatopathy, 39, 115, 247

Cardiac liver fibrosis, 125

Cardiac MRI, 269

Cardiac muscle dysfunction in LT

candidates, diagnosis and

management of, 320

350 Index

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Cardiac output (CO), 49

Cardiac paralysis, 256257

Cardiac pathology, 258

Cardiac patients

hepatic consequences in, 9698

congestive hepatopathy, 9798

drug induced liver injury, 98

hypoxic hepatitis, 98

liver function tests abnormalities, 9697

Cardiac risk assessment tools, 338339

Cardiac sclerosis, 125

Cardiac surgery, 100

Cardiac titin protein, 340

Cardiac valvular disease, 294

Cardiac-adrenergic signalling, 227

Cardio-hepatology, 8, 203

association between abnormal LFT and

impaired hemodynamics, 107108

bilirubin metabolism in liver, 107

blood supply of liver and anatomy, 105106

LFT, 105

pathophysiology of abnormal LFT in heart

failure, 106107

and prognosis in heart failure, 108111

Cardio-renal syndrome, 17

Cardiogenic ascites, 124

Cardiohepatic syndrome, 17, 105

Cardiology, 3133

Cardiomyocytes, 227228

Cardiomyopathy (CM), 101, 218, 247, 294

CCM, 219t

distinction from, 218220

Cardiopulmonary considerations for

anesthetic management of liver

transplantation

perioperative cardiovascular management

in liver transplant patient, 293302

perioperative pulmonary management in

liver transplant recipient, 302305

Cardiovascular assessment before liver

transplantation

assessment

cardiac dysrhythmias, 316319

coronary artery disease, 309316

heart failure, 319320

Cardiovascular consequences of inherited

metabolic liver failure, 258261

disorders of inborn error in energy

metabolism, 261

glycogen storage diseases, 259

hereditary hemochromatosis, 259

homozygous familial

hypercholesterolemia, 261

neonatal hemochromatosis, 259

primary hyperoxaluria type 1, 260

propionic acidemia, 260

tyrosinemia type 1, 260

Wilson disease, 260

Cardiovascular diseases (CVD), 1213, 309,

327

association between NAFLD

/nonalcoholic steatohepatitis and

CVD, 1213

association between NAFLD/hepatic

fibrosis and cardiac dysfunction, 14

definition of NAFLD /nonalcoholic

steatohepatitis, 1112

dyslipidemia as causative factors for

NAFLD /nonalcoholic steatohepatitis

and

heart failure and liver impairment,

115116

imaging markers of hepatic fibrosis in HF,

119120

liver disease associated with poor

outcomes, 116117

of heart failure, 116

liver function tests and prognosis of HF,

117118

markers of hepatic fibrosis and prognosis

of HF, 118119

underlining molecular mechanisms

between nonalcoholic steatohepatitis

and atherosclerosis, 1314

Cardiovascular dysfunction, 238, 247

Cardiovascular risk factors (CVRFs), 1213

Cardiovascular Risk in Orthotopic LT score

(CAR-OLT score), 344

Cardiovascular system, 296

Carvedilol, 52

CCM. See Cirrhotic cardiomyopathy (CCM)

CCTA. See Coronary computed tomography

angiography (CCTA)

CDCA. See Chenodeoxycholic acid (CDCA)

CE. See Cholesterol esters (CE)

Central neural mechanisms, 208

Central venous pressure (CVP), 172

Centrilobular hepatic necrosis, 116

Centrilobular necrosis, 133134

Cerebral blood flow, 211212

Cerebral circulation, 211212

CGRP. See Calcitonin gene-related peptides

(CGRP)

CH. See Congestive hepatopathy (CH)

CHD. See Congenital heart diseases (CHD);

Coronary heart disease (CHD)

Chemical thromboprophylaxis, 186

Chenodeoxycholic acid (CDCA), 256

Chest radiography, 302

CHF. See Chronic heart failure (CHF)

Child-Turcotte-Pugh score (CTP score), 316,

338

Cholanemia, 256

Cholecardia, 256258

Cholestasis, 98

Cholesterol, 13

Cholesterol esters (CE), 13

Cholic acid (CA), 256

Cholinesterase, 105, 111

Chronic alcoholism, 101

Chronic cirrhosis, cardiovascular

consequences of, 262263

Chronic heart failure (CHF), 17, 125

fundamental clinical pharmacokinetic

principles, 1823

clearance concepts, 1819

half-life, 2223

hepatic clearance and oral

bioavailability, 19

21

renal clearance, 21

volume of distribution, 22

NYHA classification of heart failure, 18t

pathophysiological changes affecting

pharmacokinetics in patients with,

2327

hepatic clearance, 2324

intestinal permeability, 23

intravenous administration of high

hepatic extraction ratio drugs, 2425

oral administration, 2526

renal clearance, 26

volume of distribution, 2627

pharmacotherapeutic implications, 27

prevalence and prognostic value of

abnormal liver function in, 117

Chronic hepatic congestion, 24

Chronic kidney disease (CKD), 275, 337

Chronic liver disease, 136

Chronic Liver Failure (CLIF), 154

beta-blockers in acute on, 55

Chronic liver injury, 118119

Chronic nontumoral portal vein thrombosis.

See also Nontumoral portal vein

thrombosis

treatment of, 7476

anticoagulation, 75

management of complications of portal

hypertension, 7475

management of portal biliopathy,

7576

transjugular intrahepatic portosystemic

shunt, 75

Chronic obstructive pulmonary disease

(COPD), 303

Chronic oral therapy, 34

Chronic passive congestion, 127, 134, 136

Chronic passive hepatic congestion, 125

Chronic pulmonary disease, 17

Chronic viral infections, 136

CI. See Confidence interval (CI)

Cirrhosis, 95, 9899, 139, 203, 207, 209,

217218, 250

albumin, 283

biomarkers, 281282

bleeding in liver diseases, 178183

cardiac dysfunction in, 279

clinical features and management of sepsis

syndromes in patients with, 157

combined liver kidney transplant, 286

concept of rebalanced hemostasis, 171175

definition and diagnostic criteria of AKI

in, 277278, 277t

diagnosis, 280281

epidemiology, 278

evolving concept of renal dysfunction in,

275276, 276f

general measures, 282283

hemodynamic changes in, 278279

hemostasis, 165167

and liver regeneration, 190

192

delivery of growth factors, 191192

delivery of platelet-derived RNA, 192

fibrin and liver regeneration, 192

platelets as initiators of inflammatory

response, 192

351Index

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Cirrhosis (Continued)

hemostatic balance in different types and

severities of liver diseases, 175178

acute liver failure, 177178

compensated cirrhosis, 175176

decompensated cirrhosis and acute-on-

chronic liver failure, 176177

fatty liver disease, 177

liver transplantation, 178

hemostatic changes in liver diseases,

167168

humans and animal models of, 204

hyperdynamic circulation of, 8

immunosuppression in, 156157

intrahepatic thrombosis and disease

progression, 188190

liver transplantation, 285286

management, 282

algorithm for management of

hepatorenal syndrome, 282f

pathophysiology, 278

of cirrhosis stages, 49

phenotypes of renal disease, 276f

pitfalls of routine diagnostic tests of

hemostasis, 168171

predictive factors for development of

hepatorenal syndrome-AKI, 280

prevention, 287

prognosis, 286287

renal replacement therapy, 285

role of inflammation, 280

sepsis in patients with, 154162

thrombosis in liver diseases, 184188

vasoconstrictors, 283285

Cirrhotic cardiomyopathy (CCM), 8, 17, 99,

115, 218, 223224, 247, 278, 295, 312,

328329

β-adrenergic signalling, 227

bile acids, 228

carbon monoxide, 229

cirrhotic cardiomyopathy and prognosis,

226

clinical significance, 221223

prevalence, 221223, 221f

studies assessing QTc reversibility

following liver transplantation, 222t

definition and diagnostic criteria, 217220

distinction from cardiomyopathies,

218220

endocannabinoids, 230231

liver transplantation, 238241

management, 231238

β-blockers, 231233

albumin, 238

antioxidant and antiinflammatory

treatments, 238

combination vasoconstrictors and

albumin, 233237

membrane fluidity, 227228

morbidity/mortality after cardiovascular

challenges, 223225

myosin heavy chain isoform shift, 229

nitric oxide, 228229

pathogenic mechanisms, 226227, 226f

reversibility

QTc prolongation, 240

systolic and diastolic function, 240241

role of ion channels in, 230

titin and collagen isoforms, 230

TNFα, 227

Cirrhotic Cardiomyopathy Consortium, 218,

332

Cirrhotic liver disease, 247

Cirrhotic nodules, 136

CKD. See Chronic kidney disease (CKD)

CKMB. See Creatine kinase MB (CKMB)

Clearance (CL), 18

CLIF. See Chronic Liver Failure (CLIF)

Clinical liver transplant program, 171172

CM. See Cardiomyopathy (CM)

CMV. See Cytomegalovirus (CMV)

CNIs. See Calcineurin inhibitors (CNIs)

CO. See Cardiac output (CO)

Coagulation, 166167, 173174

Collagen isoform, 230

Combination vasoconstrictors, 233237

β blockers in patients with CCM, 236t

liver transplantation in patients with

cardiac dysfunction, 234t

Combined coronary artery bypass graft

(CABG), 294

Compensated cirrhosis, 175176

Computed tomography (CT), 47, 68, 7778,

140141, 311

Confidence interval (CI), 12, 310

Confluent centrilobular necrosis, 134

Congenital absence of portal vein (CAPV),

249

Congenital heart diseases (CHD), 139,

247248

cardiovascular consequences of structural,

247250

Alagille syndrome, 248249

Biliary Atresia Splenic Malformation

syndrome, 249

heart defects associated with Abernathy

malformation of portal vein, 249

implications of coexisting congenital

heart diseases for LT, 249250

structural congenital heart diseases, 248t

Congestive hepatopathy (CH), 9598, 115,

123124, 136

Constrictive pericarditis, 115

COPD. See Chronic obstructive pulmonary

disease (COPD)

Coronary artery bypass grafting (CABG), 316

Coronary artery calcification (CAC), 12

Coronary artery calcium score (CACS), 311

and coronary computed tomography

angiography, 313314

Coronary artery disease (CAD), 293294,

327328

assessment, 309316

prevalence of CAD in LT candidates,

309, 310t

risk factors, 310311

management of CAD in LT candidates,

315316

advantages and disadvantages of

screening tests, 316t

screening tests for CAD in LT candidates,

311315

CACS and coronary computed

tomography angiography, 313314

dobutamine stress echocardiogram,

311313

invasive coronary angiography, 314315

myocardial perfusion imaging with real-

time myocardial contrast

echocardiography, 313

SPECTMPI, 313

Coronary artery disease in LTx score

(Coronary artery disease-LTscore), 344

Coronary artery disease-LTscore.

See Coronary artery disease in LTx

score (Coronary artery disease-

LTscore)

Coronary computed tomography

angiography (CCTA), 314

coronary artery calcium score and,

313314

Coronary heart disease (CHD), 327

Corticosteroids, 47

Creactive protein (CRP), 339

Creatine kinase MB (CKMB), 238

Creatinine, 281

Crystalloids, 283

CT. See Computed tomography (CT)

CTP score. See Child-Turcotte-Pugh score

(CTP score)

CVD. See Cardiovascular diseases (CVD)

CVP. See Central venous pressure (CVP)

CVRFs. See Cardiovascular risk factors

(CVRFs)

Cyclosporine, 336

Cystatin C, 281

Cytochrome P450 (CYP), 24, 44

Cytokine storm, 211

Cytomegalovirus (CMV), 83

infection, 100

D-xylose, 23

Damage associated molecular patterns

(DAMPs), 146148

1-deamino-8-D-arginine vasopressin

(DDAVP), 182

De novo NAD

biosynthesis, 153

DEA. See Desethylamiodarone (DEA)

Deceased donor liver transplant (DDLT), 333

Deceleration time (DT), 223

Decompensated cirrhosis, 176177

Deep vein thrombosis (DVT), 184

Defibrotide, 82

Deoxycholic acid (DCA), 256

Desethylamiodarone (DEA), 32

Diabetes mellitus, 17, 336337

Diacylglycerol (DAG), 13

Diagnostic tests, 183

Diastolic dysfunction (DD), 250, 318

Diastolic function, 240241

echocardiographic assessment of diastolic

function in cirrhotic child, 266267

Diffusing capacity for carbon monoxide

(DLCO), 303

352 Index

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Direct bilirubin (D-Bili), 105, 110, 118

Direct oral anticoagulants (DOACs), 68, 187,

318

Disease progression, 188190

Diuretics, 125126

Dobutamine stress echocardiogram (DSE),

294, 311313

Doppler ultrasound, 68, 204

Dosage adjustment, 27

Doubly-knocked out (DKO), 228

Down-titration of drug, 51

Dronedarone, 43

Drug-eluting stents (DES), 315316

Drug-induced liver injury (DILI), 41, 98

different drugs used in heart diseases, 99t

Drugs, 1719, 22, 2425, 126, 187188

absorption process, 31, 34

amiodarone effects on, 44

antibiotic strategies for drug-resistant

bacteria, 159160

comfort zone of mainstream therapeutics,

3940

determinant of drug exposure, 3435

drug-toxicity, 44

drugs-safety, 51

Dual antiplatelet therapy (DAPT), 315316

Dyslipidemia, 336

Dyslipidemia as causative factors for

NAFLD /nonalcoholic steatohepatitis

and CVD, 13

Echocardiography, 265268, 320

assessments

of diastolic function in cirrhotic child,

266267

of global function in cirrhotic child,

267268

of hepatopulmonary syndrome on

echocardiography, 268

of LV geometry in a cirrhotic child on,

265

of portopulmonary hypertension on

echocardiography, 268

of systolic function in cirrhotic child, 265

techniques, 218

Effective arterial blood volume (EABV),

278279

Efficacy of Vasopressin Antagonism in Heart

Failure Outcome Study with

Tolvaptan (EVEREST), 117

Ejection fraction (EF), 265, 294

Elastography values, 77

Electrocardiogram (ECG), 311

Electrocardiography, 128, 265

Electron microscopy, 41

End-stage liver disease (ESLD), 247, 293,

327328

Endocannabinoids, 207, 230231

mechanisms, 231

Endoscopic variceal ligation (EVL), 55

Endothelial glycocalix, 165

Endothelial NOS (eNOS), 206207

Endothelial-derived proteins, 176, 178

Endothelium, 165

Epidemiology, 278

of liver diseases in HF

diseases leading to HF and affecting

liver, 100101

liver diseases in patients with HF, 95100

and risk factors for cardiovascular

complications in liver transplantation,

327329

pathophysiology of relationship

between liver disease and

cardiovascular disease, 329f

risk factors for cardiovascular disease

events, 328t

timeline of major cardiovascular risk in

post-transplant period, 333f

Erythropoietin, 238

Escherichia coli, 158

European Association of Cardiovascular

Imaging (EACVI), 221

European Medicines Agency (EMA), 27

European society for blood and marrow

transplantation (EBMT), 7980

criteria, 80t

diagnostic criteria, 79t

European Systemic Coronary Risk

Evaluation Project (SCORE), 338

Extended-drug-resistant bacteria, 159160

Extracorporeal membrane oxygenator

(ECMO), 300

Farnesoid X receptor (FXR), 148149, 228,

256

Fatty acid binding protein (FABP), 224

Fatty acid oxidation (FAO), 257

Fatty acids, 152153

Fatty liver disease, 177

Fatty liver index (FLI), 1213

Fibrin, 184, 192

polymerization, 176

Fibrinogen, 183

Fibrinolysis, 167, 173174

Fibrinolytic shutdown, 178

Fibrinopeptide A, 110

Fibrosis, 136

development, 137

Fluorescence method-4 (Fluo-4), 230

Foie cardiaque, 3

Fontan procedure, 139140

anatomic variants of Fontan anatomy, 140f

examination to detect FALD, 141

physiology and prevalence of FALD,

140141

recommendation, 141

Fontan-associated liver disease (FALD), 97,

139140

examination to detect, 141

physiology and prevalence of, 140141

Framingham Heart Study, 317

Framingham Risk Score (FRS), 1213, 338

Free cholesterol (FC), 13

Free fatty acid (FFA), 13

Fresh-frozen plasma (FFP), 171

Fungal infections, 162

Fungi, 145

G protein-coupled bile acid receptor 1

(GPBAR1), 256

Gadolinium chloride (GdCl

), 231

Galen, 4

Gamma-glutamyl transpeptidase (GGT), 46,

96, 105, 110

Gamma-glutamyl-transferase, 1213

Gastrointestinal bleeding (GIB), 315

GDF15. See Growth and differentiation factor

15 (GDF15)

Generation theory, 3

Genome wide association study

(GWAS), 14

German Prospective Cardiovascular Munster

Study (PROCAM), 338

Gestational Alloimmune Liver Disease

(GALD), 259

Gilbert’s syndrome, 110

Glomerular filtration rate (GFR), 21, 226,

275276, 337

Glucagon, 227

Glycochenodeoxycholic acid, 228

Glycocholic acid, 228

Glycogen phosphorylase BB isoenzyme

(GPBB), 224

Glycogen storage diseases (GSD), 259

Glycoprotein (GP), 165

Graft dysfunction, 84

Graft versus host disease (GVHD), 8081

Graves’ disease, 100

Growth and differentiation factor 15

(GDF15), 153

Half-life of drug, 2223

Hazard ratio (HR), 310

Heart, 3, 31, 95

in liver failure, 8

cirrhotic cardiomyopathy, 8

hyperdynamic circulation of cirrhosis, 8

Heart failure (HF), 17, 23, 27, 95, 105,

115116, 312, 327

abnormal liver synthetic function and, 118

assessment of, 319320

diagnosis and management of cardiac

muscle dysfunction in LT candidates,

320

prevalence and risk factors, 319320

diseases leading to HF and affecting liver,

100101

congenital causes, 101

infections, 100

imaging markers of hepatic fibrosis in HF,

119120

LFT and prognosis in, 108111

albumin, cholinesterase, and total

protein, 111

gamma-glutamyltranspeptidase and

alkaline phosphatase, 110

hepatic fibrotic markers in, 111

prothrombin time international

normalized ratio, 110111

total and direct bilirubin, 110

transaminases, 110

353Index

https://t.me/medicina_free

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