Takotsubo cardiomyopathy following liver transplantation - a multicenter cohort study

Objective: Takotsubo cardiomyopathy (TCM) is an acute, stress-mediated, reversible cardiomyopathy that occurs in the absence of hemodynamically significant coronary artery disease. We aimed to investigate the characteristics and outcomes of patients who developed TCM following liver transplantation (LT) in a multicenter study. Methods: Adult patients from six centers across the US who developed TCM according to Mayo Clinic criteria following LT between 2008-2023 were included. Demographics, perioperative and long-term outcomes, and treatment modalities were assessed. Results: Fifty-five patients were included. The center incidence of TCM ranged from 0.1 - 0.5%. The majority were female (54.5%) and Caucasian (87.2%), and median age at transplant was 59 years. The primary etiologies for LT were alcohol-related cirrhosis (49.1%) and metabolic dysfunction-associated steatotic liver disease cirrhosis (21.8%). The median time from LT to TCM diagnosis was 4 days. TCM was associated with a 60.9% reduction in left ventricular ejection fraction (LVEF) from a pretransplant median LVEF of 64.0% to 25.0%. The most common treatment for TCM was diuretics (67.3%) and afterload reduction (54.5%), with only 27.3% of patients requiring vasopressor support. At median follow-up 31.5 months, 1-year and 3-year overall survivals were 86.3% and 69.4%, respectively. Repeat echocardiogram performed at a median of 84 days demonstrated 45/55 patients (81.8%) had recovered LVEF ≥50%. Patients with LVEF recovery to ≥50% had significantly improved overall survival (OS) compared to those without LVEF recovery >50% (106.4 mos vs. 12.2 mos, p=0.001). Conclusion: TCM following LT is associated with a significant reduction in LVEF, however the majority of patients recover LVEF to > 50% with minimal perioperative mortality. Importantly, follow-up assessment of LVEF has significant implications as lack of recovery is associated with worse OS.