Prevalence of cirrhotic cardiomyopathy and its correlation with serum pro-BNP levels, hepatorenal syndrome (HRS), SBP (spontaneous bacterial peritonitis) and mortality – An Indian study

Abstract

Background and Aims: Decompensated liver cirrhosis is characterized by a peripheral vasodilation with a low-resistance hyperdynamic circulation which leads to sustained increase of cardiac work load resulting in an inconstant and often subclinical series of heart abnormalities, constituting a new clinical entity known as “cirrhotic cardiomyopathy”. This study aims at estimating the Prevalence of Cirrhotic Cardiomyopathy and its correlation with S.pro-BNP levels, hepatorenal syndrome (HRS), SBP (Spontaneous bacterial peritonitis) And Mortality. Methods: This was a prospective study where Doppler Echocardiography which is a newer sensitive technique was used to detect diastolic dysfunction in all cirrhotic patient enrolled in this study. We used this newer technique and also did conventional 2D and Doppler echocardiography in cirrhotic patients. Additionally, QTc interval, pro-BNP, Tropinin T levels were measured. Ultrasound abdomen, UGI endoscopy, Doppler SPA, MELD score and CTP were done. Patients were followed up for 6 month to look for any new complications that developed like hepato-renal syndrome (HRS), Spontaneous bacterial peritonitis (SBP)(Using standard definition) or any mortality. Result: In our study 53 cirrhotic patients were compared with 30 controls. The results in 53 cirrhotic patients (mean age-43.88±13.58yr, M:F::: 49:4)etiology:alcoholic-27,nonalcoholic-26,child score (A-0,B-31,C-32), MELD Score were 18.17±1.69 in diastolic dysfunction group and 16.36±1.70 in cirrhotic without diastolic dysfunction. Doppler Echocardiography showed mean early diastolic velocity of 11.6±2.6 vs. 19.8±6 cm/sec (P<0.01) and mean late diastolic velocity of 10.7±2.9 vs. 8.4±3.1cm/sec (P<.05).The mean Doppler E- velocity was 0.76±.16 vs. 0.88±0.14 (P<0.05),A-velocity was 0.72±0.25 vs. 0.53±0.11 (P<0.01),DT was 218.4±43.8 vs. 212.9±61.9 (P -NS) and E/A ratio was 1.14±0.34 vs. 1.7 ±0.43(P<0.01).The troponin-t levels were <.01ng/ml(normal range).The mean pro-BNP level was 408±341.10pg/ml(normal for our lab <125 pg/ml).Mean QTc interval was 481.9±53.8msec. Conclusion: This study showed that diastolic dysfunction is highly prevalent (43% of study population) in cirrhosis. QTc interval and BNP were also significantly raised. In addition cirrhotic complications like HRS, SBP and hepatic encephalopathy were more common in cirrhotic cardiomyopathy group. Hence diastolic dysfunction is highly prevalent in cirrhosis and positively correlated with degree of liver dysfunction and there was a statistically insignificant increase in cirrhotic complication in cirrhotic cardiomyopathy group.