In HCV-related liver cirrhosis, local pulse wave velocity increases and in decompensated patients correlates with poorer survival.

Chien-Hao Huang,Yu-Fu Cheng,Chun-Yen Lin,I-Shyan Sheen,Yu-Shien Ko,Wen-Juei Jeng,Lung-Sheng Wu,Giuseppina Novo

doi:10.1371/journal.pone.0212770

Chien-Hao Huang, Yu-Fu Cheng + Show 6 more

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https://doi.org/10.1371/journal.pone.0212770

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Abstract

BackgroundCirrhotic cardiomyopathy (CCM) refers to cardiac dysfunction in patients with liver cirrhosis, in the absence of other known cardiac disease.MethodsControl group and patients diagnosed of liver cirrhosis without known cardiac disease or hepatocellular carcinoma were enrolled for this clinical observation study. Patients with diabetes mellitus, hypertension were excluded. Absolute global longitudinal strain, one-point carotid pulse wave velocity (one-point PWV) and various parameters were measured in resting status.ResultsThere were 29 participants in the control group and 80 patients in the liver cirrhosis group. 27.8% of cirrhotic patients presented with normal systolic but abnormal diastolic functions and QTc prolongation that were compatible with CCM. 34.2% of cirrhotic patients presented with diastolic dysfunction in resting state comparing to 24.1% in control group. Systolic functions did not show conspicuous difference between cirrhosis and control group nor between compensated and decompensated cirrhosis, neither. Furthermore, one-point PWV was significantly higher in liver cirrhosis than in control group and higher in CCM than in non-CCM patients. One-point PWV predicted CCM and diastolic dysfunction in cirrhosis. Most importantly, its value > 1370cm/s predicted overall mortalities in decompensated cirrhosis (multivariable Cox analysis OR = 6.941) in addition to CTP score specifically in HCV related cirrhotic patients (AUC = 0.817).ConclusionsIn patients with cirrhosis, 27.8% were diagnosed with CCM by resting cardiovascular parameters. One-point PWV increased in CCM, correlated with diastolic dysfunction. It also correlated with overall mortality in patients with hepatitis C virus (HCV) related decompensated cirrhosis. Further study may be needed to confirm its capability for assessing CV and mortality risks in HCV related decompensated cirrhotic patients.

Highlights

The term cirrhotic cardiomyopathy (CCM) is used to describe cirrhotic patient with normalto-elevated cardiac output and contractility at rest but a blunted response to pharmacologic, physiologic, or pathologic stress[1]
There were 29 participants in the control group and 80 patients in the liver cirrhosis group. 27.8% of cirrhotic patients presented with normal systolic but abnormal diastolic functions and QTc prolongation that were compatible with CCM. 34.2% of cirrhotic patients presented with diastolic dysfunction in resting state comparing to 24.1% in control group
One-point Pulse wave velocity (PWV) increased in CCM, correlated with diastolic dysfunction

Summary

Introduction

The term cirrhotic cardiomyopathy (CCM) is used to describe cirrhotic patient with normalto-elevated cardiac output and contractility at rest but a blunted response to pharmacologic, physiologic, or pathologic stress[1]. Because of the presence of substantial peripheral vasodilation, cirrhotic patients are less likely to develop severe or overt heart failure[2]. Situations that involve substantial cardiac stress, such as sepsis, surgery, or transjugular intrahepatic portosystemic shunt insertion, may reveal the limited ventricular reserve and cause severe heart failure[2] or death after liver transplantation[3]. It is important to investigate latent heart failure at rest or before stress and to identify cardiac factors associated with mortality. Cirrhotic cardiomyopathy (CCM) refers to cardiac dysfunction in patients with liver cirrhosis, in the absence of other known cardiac disease

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Conclusion