42. A study of cardiovascular dysfunction in cirrhosis of liver & its correlation with the severity of cirrhosis in Eastern India

Abstract

Background and Aims: Cirrhosis of liver is associated with subclinical cardiovascular (CVS) dysfunction characterized by diminished systolic responsiveness to stress stimuli, impaired diastolic relaxation, electrophysiological abnormalities, and enlargement and hypertrophy of cardiac chambers, all in the absence of known cardiac disease. However, evidence suggests that patients with cirrhosis display primarily left ventricular diastolic dysfunction (LVDD) with normal systolic function at rest. We aim to evaluate cardiovascular dysfunction in patients of cirrhosis and its correlation with severity of liver cirrhosis as by Child pugh turcotte (CPT) and MELD scoring system and circulatory function. Methods: Prospective observational study, where CVS evaluation of 60 patients (20 patients each in CHILD A, B and C) was done by both conventional 2D and tissue Doppler echocardiography. Statistical analysis was done using SPSS 20 software and p < 0.05 considered significant. Results: GR1, GR2 And GR3 LVDD were present in 23.33%, 43.33% and 20% of the patients respectively. Patients with LVDD had significantly higher (p < 0.05) left atrial diameter (LAD), E wave transmitral /early diastolic mitral annular velocity (E/e ratio), pulmonary arterial systolic pressure (PASP), natriuretic peptide level, CTP and MELD score. GR2 and GR3 LVDD were associated with ascites and increased plasma renin activity compared to GR 1 LVDD and without LVDD suggestive of direct correlation between LVDD and circulatory dysfunction. Heart rate and systolic function were normal in all cases. Survival was not different according to the degree of LVDD (p = 0.739) in 3 groups of patients. Conclusions: LVDD occurs simultaneously with other changes in cardiac structure and function in cirrhosis and is associated with circulatory dysfunction. Both conventional 2D Echocardiography and tissue Doppler imaging (TDI) are non-invasive, real-time, rapid imaging technology with a high accuracy for diagnosing CVS abnormalities, such as those indicative of cirrhotic cardiomyopathy. The authors have none to declare.