Myocardial Contractile Function in Patients with Liver Cirrhosis and Syndrome of Bacterial Overgrowth Syndrome

Abstract

to study myocardial contractile function in patients with liver cirrhosis and ascites in the presence of bacterial overgrowthsyndrome (BOS) and pathological bacterial translocation. We included in this study 59 patientswith Child-Pugh class B and C liver cirrhosis (LC) of various etiology and ascites. Control group comprised 12 patients withischemic heart disease complicated by chronic heart failure (CHF). Examination included history taking and laboratory andinstrumental investigation. LC was diagnosed basing on clinical symptoms and instrumental studies. Child-Pugh and MELDscores were used for assessment of LC severity and prognosis. International ascites club grading system was used for evaluationof severity of ascites. Hydrogen breath test was applied for diagnosing BOS. Syndrome of pathological bacterial translocationwas established based on blood levels of lipopolysaccharide-binding protein and detection of bacterial DNA in ascitic fluid.Structural-functional parameters of the myocardium and hemodynamics were assessed by echocardiography. Brain natriureticpeptide (BNP) concentration was measured in blood serum and ascitic fluid. In 13 of 59 patients with LC the hydrogenbreath test was negative, in 33 positive and in 13 patients the positive hydrogen test was combined with the presence of BOSand pathological bacterial translocation. Blood serum and ascitic fluid BNP concentrations in LC patients were low and withinnormal limits (62.5±4.1 and 53.3±4.9 rg / ml, respectively), what contrasted with high BNP concentrations in patients withCHF (1820±95.5 and 497.1±39.6 rg / ml, respectively). Total protein level in ascitic fluid also was significantly lower in patientswith LC than in patients with CHF (1.77±0.1 and 4.43±0.35 mg / dL, respectively). The serum-ascitic albumin gradient(SAAG) in both groups of patients exceeded 1.1 (1.58±0.13 in patients with CHF and 1.88±0.19 in patients with LC).Conclusions. In patients with liver cirrhosis the presence of BOS and bacterial translocation did not produce a distinct negativeimpact on contractile function.