Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2022; 14(2): 400-410
Published online Feb 27, 2022. doi: 10.4254/wjh.v14.i2.400
Takotsubo cardiomyopathy in orthotopic liver transplant recipients: A cohort study using multi-center pooled electronic health record data
Mohammad Zmaili, Jafar Alzubi, Motasem Alkhayyat, Joshua Cohen, Saqer Alkharabsheh, Mariam Rana, Paulino A Alvarez, Emad Mansoor, Bo Xu
Mohammad Zmaili, Joshua Cohen, Saqer Alkharabsheh, Paulino A Alvarez, Bo Xu, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Jafar Alzubi, Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, United States
Motasem Alkhayyat, Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Mariam Rana, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, United States
Emad Mansoor, Department of Gastroenterology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, United States
Author contributions: Zmaili M designed the research study and formulated the idea of the research topic, collected the data, wrote the manuscript, contributed to the statistical analysis and figure formatting; Alzubi J contributed to manuscript writing; Alkhayyat M contributed to manuscript writing, data collection, data analysis, and figure formatting; Cohen J contributed to manuscript writing and revision; Alkharabsheh S contributed to manuscript writing and revision, and data analysis; Rana M contributed to manuscript writing; Alvarez PA contributed to manuscript writing and revision; Mansoor E contributed to manuscript writing and revision; Xu B contributed to manuscript writing and revision, finalizing the research work.
Institutional review board statement: This study is based on a multicenter analytics and research platform developed by IBM Watson Health (Explorys Inc, Cleveland, OH, USA). At present, Explorys database is rich, integrated, and growing living clinical data set that is HIPAA-enabled, including more than 70 million unique patients across all 50 states in the United States, and thus provides a broad regional and climatic distribution of source population. Ethical review and informed consent were waived, since there are no identifiers associated with any of the patient data. The Explorys rounds cell counts to the nearest 10 and treats all cell counts between zero and 10 as equivalent in order to further protect the identities of patients. In other words, the identities of subjects is completely anonymous and there is no risk involved in the study. Additionally, the research presents no risk of harm to subjects and involves no procedures for which written consent is normally required outside the research context.
Conflict-of-interest statement: This statement is to certify that all Authors have seen and approved the manuscript being submitted. We warrant that the article is the Authors' original work. We certify that there is no actual or potential conflict of interest in relation to this article to declare.
Data sharing statement: This study is based on a multicenter analytics and research platform developed by IBM Watson Health (Explorys Inc, Cleveland, OH, USA). At present, Explorys database is rich, integrated, and growing living clinical data set that is HIPAA-enabled, including more than 70 million unique patients across all 50 states in the United States, and thus provides a broad regional and climatic distribution of source population. Ethical review and informed consent were waived, since there are no identifiers associated with any of the patient data. The Explorys rounds cell counts to the nearest 10 and treats all cell counts between zero and 10 as equivalent in order to further protect the identities of patients. In other words, the identities of subjects is completely anonymous and there is no risk involved in the study. Additionally, the research presents no risk of harm to subjects and involves no procedures for which written consent is normally required outside the research context.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Xu, MD, FACC, FRACP, FASE, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, United States. xub@ccf.org
Received: June 29, 2021
Peer-review started: June 29, 2021
First decision: July 27, 2021
Revised: August 8, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: February 27, 2022
Processing time: 238 Days and 7.6 Hours
ARTICLE HIGHLIGHTS
Research background

Orthotopic liver transplant recipients are a particularly vulnerable patient population with an elevated risk of developing various complications. Takotsubo cardiomyopathy (TCM) is one of the complications that is thought to have an association with liver transplantation, and can impact the overall prognosis.

Research motivation

Limited data is available regarding the association between orthotopic liver transplantation and TCM. The current research study evaluated this proposed association, and investigated the predictors and outcomes in this specific patient population.

Research objectives

To study the association between orthotopic liver transplantation and TCM, provide details about the demographic characteristics of the patient cohort, and examine the factors that affect the development of TCM in liver transplant patients, with a focus on identifying predictive variables and associated outcomes.

Research methods

Using a multi-center database of de-identified electronic health record data, a cohort of patients who underwent orthotopic liver transplant during the study period was identified. The sample was investigated to reveal the subset of patients who developed TCM. The data was analyzed to evaluate the association of TCM and liver transplantation, and descriptive statistical methods were utilized to demonstrate the specific features pertaining to the cohort of interest.

Research results

The study revealed that TCM is more likely to develop in liver transplant recipients compared to non-recipients. Predictors for the development of this association are described, with older age, female gender, and Caucasian ethnicity being a few notable risk factors. The research study also showed a higher incidence of poor outcomes in liver transplant patients who develop TCM, including but not limited to, cardiogenic shock, cardiac arrest, and multi-organ failure.

Research conclusions

Liver transplant recipients are a vulnerable patient population who have a higher risk of developing TCM. The development of this cardiac complication is associated with a heightened rate of in-hospital complications. Knowledge of preexisting risk factors may help identify high-risk patients, and can impact management decisions.

Research perspectives

Future multicenter, prospective research studies focusing on risk factors and predictors of TCM in orthotopic liver transplant recipients are required, in order to fully explore this disease association and confirm the various outcomes observed in this patient population.