Prevalence of cardiac and renal dysfunction in Indian cirrhotic patients

Abstract

Aims: The objective was to assess the prevalence of cirrhotic cardiomyopathy in patients with cirrhosis of liver and its correlation to hepatorenal syndrome (HRS), to assess if echocardiographic parameters of cardiac dysfunction correlate with the severity of liver dysfunction, and to appraise whether or not there are significant differences in these parameters between patients with alcoholic and nonalcoholic cirrhosis. Methods: After approval from institutional ethics committee, twenty nine patients with alcoholic cirrhosis and twenty nine with cirrhosis of non-alcoholic etiology were enrolled, after excluding those with recent bleeding, gross ascites, severe anemia and other conditions which could alter cardiovascular status. Twenty nine healthy subjects without cardiovascular risk factors were enrolled as controls. Hepatic function status was assessed by biochemical tests and prothrombin time. Cardiac structural and functional assessment was performed non-invasively using transthoracic echocardiography. Results: Prevalence of cirrhotic cardiomyopathy in our study was found to be 25.86%. Deceleration time was significantly (P < 0.05) prolonged in both the cirrhotic groups (231.2 ± 23.9 ms and 228.7 ± 28.15 ms) compared to controls (182.5 ±17.12 ms), indicative of diastolic dysfunction in cirrhotic patients. Other parameters such as ejection fraction, E: A ratio, left ventricular relative wall thickness, inter-ventricular septal thickness, left ventricular systolic as well as diastolic chamber dimensions did not show statistically significant difference between any of the groups. No statistically significant association was seen between severity of hepatic dysfunction and cardiac changes and also between cardiac dysfunction and HRS. HRS developed in two patients. There was no statistically significant difference between the alcoholic and nonalcoholic groups. Conclusions: Diastolic dysfunction is prevalent in patients with cirrhosis. Cardiac structural and functional parameters did not correlate with the severity of liver dysfunction. Cardiac dysfunction seemed to be the consequence of cirrhosis itself, rather than of alcohol. HRS was not found to be correlated to diastolic dysfunction in cirrhotic patients.