Abstract
Aim. To study the effect of antiviral therapy on some hemodynamic parameters of the heart and the liver in patients with viral cirrhosis. Material and methods. In 75 patients with chronic viral cirrhosis evaluation of segmental systolic and diastolic function using pulsed tissue Doppler mapping and global diastolic function by the method of Doppler echocardiography was performed. Blood flow in the veins of the liver was determined by means of ultrasonic Dopplerography. 16 patients had previously received antiviral therapy - interferon combined with ribavirin - with the formation of a sustained virologic response (1st group), the remaining 59 (2nd group) had never received antiviral therapy. The control group consisted of 19 healthy individuals. Results. In patients with chronic viral cirrhosis the increase of the left atrium, diastolic and systolic dimensions, sphericity index and left ventricle mass (p<0.001) were revealed. The right ventricle increased in size with the impairment of its diastolic function and the reduction in longitudinal systolic velocity while pulmonary artery and its branches expanded with the increase of flow velocity in it (p<0.001). Dilation of the splenic vein in the 1st (30%) and 2nd groups (46%) was detected as compared with the control group (p<0.001). Standard deviation normal to normal (SDNN) of RR interval durations reflecting general autonomic tone increased in the 1st and 2nd groups and it was 42% and 62% lower, respectively, in comparison with this index in the control group (p<0.001). These disorders prevailed in patients who were not receiving antiviral therapy, moreover, they showed acceleration of blood flow in the hepatic vein and reduction in longitudinal systolic velocity at the fibrous ring of the mitral valve (p<0.001). The correlation between systolic velocity on the fibrous ring of the mitral valve, high viral load and a diameter of splenic vein was revealed. Conclusion. Evidence suggests that patients not treated with antiviral therapy have worse prognosis and hemodynamics of the heart and liver than patients who receive specific treatment.
Highlights
Standard deviation normal to normal (SDNN) of RR interval durations reflecting general autonomic tone increased in the 1st and 2nd groups and it was 42% and 62% lower, respectively, in comparison with this index in the control group (p
У таких пациентов это происходит в результате прямого цитотоксического эффекта вируса и индуцированных им иммунных нарушений, приводящих к необратимым изменениям печени с прогрессированием портальной гипертензии – наблюдается ускорение кровотока в печеночной вене
Summary
These disorders prevailed in patients who were not receiving antiviral therapy, they showed acceleration of blood flow in the hepatic vein and reduction in longitudinal systolic velocity at the fibrous ring of the mitral valve (p
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