Association of Cardiac Abnormalities to the Frail Phenotype in Cirrhotic Patients on the Waitlist: From the Functional Assessment in Liver Transplantation (FrAILT) Study.

ABSTRACT Background Frailty is a syndrome of decreased physiologic reserve that results from compromise of multiple physiologic systems including cardiovascular. We aimed to determine the association between the frail phenotype and cardiac abnormalities in liver transplant (LT) candidates through evaluation of transthoracic echocardiography (TTE) indices. Methods Included were consecutive outpatients listed for LT who underwent a frailty assessment from 1/1/14-6/30/16 (using the Liver Frailty Index) and a 2-dimensional/doppler TTE exam. Patients were categorized as robust, intermediate frail, or frail by the Liver Frailty Index based on scores of 34cc/m2 (p= 0.001). In linear regression adjusted for age, sex, hypertension and diabetes, the Liver Frailty Index was positively associated with LA dimension (coeff 0.20, 95%CI 0.07-0.34), LAVIcc/m2 (coeff 0.01, 95%CI 0.005-0.02), ejection fraction (coeff 1.59, 95%CI 0.32-2.85) and pulmonary artery systolic pressure (coeff 0.01, 95%CI 0.003-0.02) and negatively associated with LV hypertrophy (coeff -0.22, 95%CI -0.37, -0.06). Conclusion In LT candidates, frailty is associated with cardiac structural and functional changes, independent of known risk factors. Our study provides evidence to support that measures of frailty in cirrhotic patients encompass abnormalities of the cardiovascular system and may inform assessments of cardiovascular reserve in this population. CORRESPONDENCE INFORMATION: Jennifer C. Lai, MD, MBA, Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA, 513 Parnassus Avenue, UCSF Box 0538, San Francisco, CA 94143, Email: Jennifer.lai@ucsf.edu, Academic office: (415) 476-2777 AUTHORSHIP Puchades:Study concept and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content. Chau: Study design; acquisition of data, interpretation of data; critical revision of the manuscript for important intellectual content. Dodson: Study design; interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content. Mohamad: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Mustain: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Lebsack: Study design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Aguilera: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Prieto: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Lai: Study concept and design; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content; statistical analysis and study supervision. DISCLOSURE: The authors of this manuscript have no conflicts of interest to disclose. FUNDING: This study was funded by the Spanish Transplantation Society (Puchades), an American College of Gastroenterology Junior Faculty Development Award (Lai), P30AG044281 (UCSF Older Americans Independence Center; Lai), and K23AG048337 (Paul B. Beeson Career Development Award in Aging Research; Lai). These funding agencies played no role in the analysis of the data or the preparation of this manuscript. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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