Reviewer's report
Title:Prevalence of pre-transplant electrocardiographic abnormalities and
post-transplant cardiac events in patients with liver cirrhosis
Version:2Date:11 January 2014
Reviewer: Aurore BRONDEX
Reviewer's report:
Major Compulsory Revisions
1/ Prevalence of ECG abnormalities : it seems that the studied population
(n=186) is not representative of the 234 patients with cirrhosis undergoing liver
transplantation described in this study : indeed, table 1 shows differences
concerning the etiology of cirrhosis, cardiovascular risk factors (arterial
hypertension, diabetes mellitus) and proportion of coronary investigation.
Furthermore, no data are available concerning the prevalence of CAD in these 2
groups.
2/ This study lacks data on cardiovascular risk factors (obesity and dyslipidemia
were not taken into account)and cardiovascular diseases (particularly CAD,
hypertensive cardiopathy, arrhythmias) in the studied cirrhotic patients. These
could account for ECG abnormalities, more than cirrhosis itself and more than
reported associated factors such as male gender, age, smoking, arterial
hypertension, severity and etiology of cirrhosis. To note, these patients seem to
have underwent echocardiography (cohort previously used, cf reference 13) and
testing for CAD, so data about underlying cardiopathy or CAD should be
available. In the same way, it would have been interesting to study the correlation
between "ECG positive for CAD" and diagnosed CAD, as these ECG
abnormalities are not specific.
3/ Concerning the prevalence of ECG abnormalities and the risk of cardiac
events, there are major confounding variables in this study. It seems
inappropriate to compare ECG abnormalities and outcome of a healthy cohort,
without CAD or known cardiovascular disease, without cirrhosis, not undergoing
any surgery, with ECG abnormalities and outcome of cirrhotic patients
undergoing a major surgery, whose coronary status and cardiovascular medical
past is not described (to note, litterature reports a prevalence of CAD up to 26%
in cirrhotic patients undergoing transplantation, which is a lot more than in
general and "healthy" population). Moreover, data concerning cardiovascular risk
factors in these 2 populations are not available.
4/ Concerning the relation of pre-transplant ECG abnormalities to post-transplant
cardiac morbidity and mortality : both are probably related to preexisting
cardiovascular diseases (particularly hypertensive cardiopathy, arrhythmias and
CAD) that were not taken into account in this study. Thus the relation of
pre-transplant ECG abnormalities to post-transplant cardiac morbidity and
mortality cannot be clearly established.
Minor Essential Revisions
Tables count : 5 rather than 4.
Discretionary Revisions
None
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Prevalence of pre-transplant electrocardiographic abnormalities and
post-transplant cardiac events in patients with liver cirrhosis
Version:2Date:11 January 2014
Reviewer: Aurore BRONDEX
Reviewer's report:
Major Compulsory Revisions
1/ Prevalence of ECG abnormalities : it seems that the studied population
(n=186) is not representative of the 234 patients with cirrhosis undergoing liver
transplantation described in this study : indeed, table 1 shows differences
concerning the etiology of cirrhosis, cardiovascular risk factors (arterial
hypertension, diabetes mellitus) and proportion of coronary investigation.
Furthermore, no data are available concerning the prevalence of CAD in these 2
groups.
2/ This study lacks data on cardiovascular risk factors (obesity and dyslipidemia
were not taken into account)and cardiovascular diseases (particularly CAD,
hypertensive cardiopathy, arrhythmias) in the studied cirrhotic patients. These
could account for ECG abnormalities, more than cirrhosis itself and more than
reported associated factors such as male gender, age, smoking, arterial
hypertension, severity and etiology of cirrhosis. To note, these patients seem to
have underwent echocardiography (cohort previously used, cf reference 13) and
testing for CAD, so data about underlying cardiopathy or CAD should be
available. In the same way, it would have been interesting to study the correlation
between "ECG positive for CAD" and diagnosed CAD, as these ECG
abnormalities are not specific.
3/ Concerning the prevalence of ECG abnormalities and the risk of cardiac
events, there are major confounding variables in this study. It seems
inappropriate to compare ECG abnormalities and outcome of a healthy cohort,
without CAD or known cardiovascular disease, without cirrhosis, not undergoing
any surgery, with ECG abnormalities and outcome of cirrhotic patients
undergoing a major surgery, whose coronary status and cardiovascular medical
past is not described (to note, litterature reports a prevalence of CAD up to 26%
in cirrhotic patients undergoing transplantation, which is a lot more than in
general and "healthy" population). Moreover, data concerning cardiovascular risk
factors in these 2 populations are not available.
4/ Concerning the relation of pre-transplant ECG abnormalities to post-transplant
cardiac morbidity and mortality : both are probably related to preexisting
cardiovascular diseases (particularly hypertensive cardiopathy, arrhythmias and
CAD) that were not taken into account in this study. Thus the relation of
pre-transplant ECG abnormalities to post-transplant cardiac morbidity and
mortality cannot be clearly established.
Minor Essential Revisions
Tables count : 5 rather than 4.
Discretionary Revisions
None
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Prevalence of pre-transplant electrocardiographic abnormalities and
post-transplant cardiac events in patients with liver cirrhosis
Version:2Date:11 January 2014
Reviewer: Aurore BRONDEX
Reviewer's report:
Major Compulsory Revisions
1/ Prevalence of ECG abnormalities : it seems that the studied population
(n=186) is not representative of the 234 patients with cirrhosis undergoing liver
transplantation described in this study : indeed, table 1 shows differences
concerning the etiology of cirrhosis, cardiovascular risk factors (arterial
hypertension, diabetes mellitus) and proportion of coronary investigation.
Furthermore, no data are available concerning the prevalence of CAD in these 2
groups.
2/ This study lacks data on cardiovascular risk factors (obesity and dyslipidemia
were not taken into account)and cardiovascular diseases (particularly CAD,
hypertensive cardiopathy, arrhythmias) in the studied cirrhotic patients. These
could account for ECG abnormalities, more than cirrhosis itself and more than
reported associated factors such as male gender, age, smoking, arterial
hypertension, severity and etiology of cirrhosis. To note, these patients seem to
have underwent echocardiography (cohort previously used, cf reference 13) and
testing for CAD, so data about underlying cardiopathy or CAD should be
available. In the same way, it would have been interesting to study the correlation
between "ECG positive for CAD" and diagnosed CAD, as these ECG
abnormalities are not specific.
3/ Concerning the prevalence of ECG abnormalities and the risk of cardiac
events, there are major confounding variables in this study. It seems
inappropriate to compare ECG abnormalities and outcome of a healthy cohort,
without CAD or known cardiovascular disease, without cirrhosis, not undergoing
any surgery, with ECG abnormalities and outcome of cirrhotic patients
undergoing a major surgery, whose coronary status and cardiovascular medical
past is not described (to note, litterature reports a prevalence of CAD up to 26%
in cirrhotic patients undergoing transplantation, which is a lot more than in
general and "healthy" population). Moreover, data concerning cardiovascular risk
factors in these 2 populations are not available.
4/ Concerning the relation of pre-transplant ECG abnormalities to post-transplant
cardiac morbidity and mortality : both are probably related to preexisting
cardiovascular diseases (particularly hypertensive cardiopathy, arrhythmias and
CAD) that were not taken into account in this study. Thus the relation of
pre-transplant ECG abnormalities to post-transplant cardiac morbidity and
mortality cannot be clearly established.
Minor Essential Revisions
Tables count : 5 rather than 4.
Discretionary Revisions
None
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.
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