J Electrocardiol. 2026 Sep 23;99:154459. doi: 10.1016/j.jelectrocard.2026.154459. Online ahead of print.
ABSTRACT
BACKGROUND: Cardiovascular disease accounts for approximately 20% of deaths among post-liver transplant (LT) patients. Although electrocardiograms (ECGs) are commonly included in pre-transplant evaluations, their association with long-term major adverse cardiovascular events (MACE) has not been well studied.
METHODS: We retrospectively studied 298 patients who underwent LT at a tertiary academic center, 2014-2024. Pre-LT ECGs were reviewed by trained readers blinded to clinical outcomes. The primary outcome was MACE (cardiovascular death, myocardial infarction, coronary revascularization, hospitalization for unstable angina, heart failure hospitalization, ischemic stroke, or arrhythmia requiring hospitalization).
RESULTS: Among 298 patients, 63 (21.1%) experienced MACE over a median follow-up of 4.6 years (IQR 2.3-7.2). Anterior T-wave inversion (TWI) (n = 26, 8.7%) showed the strongest association in exploratory lead-distribution analysis; inferior and lateral TWI were not. After adjustment for age, diabetes, atrial fibrillation, and coronary artery disease (CAD), anterior TWI remained independently associated with MACE (adjusted HR 2.17; 95% CI 1.07-4.41) and was modified by CAD status (interaction p = 0.017): among patients without known CAD the adjusted HR was 5.11 (95% CI 2.18-11.97). Excess risk was confined to heart failure (cause-specific HR 3.98; 95% CI 1.51-10.49). Adding anterior TWI did not improve discrimination (3-year AUC 0.765 vs 0.727).
CONCLUSION: In this single-center study, anterior TWI on pre-transplant ECG was independently associated with an increased risk of MACE after LT, an association concentrated among candidates without known CAD and driven by heart failure. Because the lead-distribution comparison was exploratory and anterior TWI did not improve model discrimination, external validation is required before it is adopted for formal risk stratification.
PMID:42826628 | DOI:10.1016/j.jelectrocard.2026.154459