Cardiac Dysfunction in Cirrhotic Patients

Abstract

Introduction:In the last 20 years a number of evidences suggested that cirrhosis regardless of its etiology, is associated with major cardiovascular anomalies. Overall these alterations are known as cirrhotic cardiomyopathy and a wide range of cardiovascular abnormalities including hyperdynamic circulation, enlargement or hypertrophy of different cardiac chambers and electrophysiological changes such as QT prolongation. Aim of the work:to study the pattern and the extent of cardiac affection in cirrhotic patients and its relation to the Child-Pugh classification and its relation to MELD score. Patients and Methods: Our study was carried out on 45 patients with liver cirrhosis, the diagnosis was depending on clinical evidence of stigmata of chronic liver disease (e.g.jaundice, ascites, etc), Ultrasonographic features of liver cirrhosis (e.g coarse echo texture, shrunken liver, etc) and laboratory investigations. Our study included 15 healthy controls. All patients were subjected to the complete history taking and physical examination, laboratory investigations: Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), serum alkaline phosphatase, serum albumin, Prothrombin time and concentration, Total, direct bilirubin, hepatitis markers for HBV and HCV, blood sugar, Hb , serum Creatinine, serum Sodium and serum Potassium, echo Doppler study included chamber sizes, interventricular septum diameter, ejection fraction and diastolic function. All patients were classified according to the child-pugh classification and were be scored according to MELD score. Results:In our study, only 22% of cases had no diastolic dysfunction, compared to 67% of controls. Also, 13.3% of cases had grade 2 diastolic dysfunction, compared to zero among controls. The difference was statistically significant. Diastolic dysfunction was significantly higher among Child class B and C compared to A (p=0.020). Although MELD increases steadily with second grade diastolic dysfunction, the difference was non significant. Diastolic dysfunction was more common among patients with larger amont of ascites, with significant difference. HE was significantly associated with diastolic dysfunction. Conclusion:Our study concluded that diastolic dysfunction is an important pathological complication associated with liver cirrhosis and is directly related to the severity of liver cirrhosis.