Abstract
Background: Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. Methods: This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline. Results: RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis. Conclusions: RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling.
Highlights
One decade ago, the term “cirrhotic cardiomyopathy” was first introduced, which usually refers to the left ventricular (LV) diastolic dysfunction, an inadequate LV response to the stress or prolonged QT interval, in the absence of known cardiac disease [1,2]
The present study revealed several important findings: (i) right ventricular (RV) mechanics was impaired in patients with end-stage liver cirrhosis. (ii) All myocardial layers were affected in cirrhotic patients. (iii) right atrial (RA) phasic function was deteriorated in patients with cirrhosis when compared with controls. (iv) Model for End-stage Liver Disease (MELD) score, as an important predictor of three-month mortality in patients with liver cirrhosis, correlated with parameters of RV remodeling and RA phasic function in cirrhotic patients
The RV strain is reduced for the whole ventricle, and for the RV-free wall, which indicates that cirrhosis has an independent effect on the RV
Summary
The term “cirrhotic cardiomyopathy” was first introduced, which usually refers to the left ventricular (LV) diastolic dysfunction, an inadequate LV response to the stress or prolonged QT interval, in the absence of known cardiac disease [1,2]. There are only a few studies that investigated cardiac remodeling in cirrhotic patients, subjects with non-alcoholic fatty liver disease, or liver cirrhosis using strain analysis [4,8,9,10]. There is no data regarding RV layer-specific changes and right atrial (RA) phasic function in the patients with end-stage liver cirrhosis. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. Diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Conclusions: RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Bilirubin, and the MELD score correlated with RV and RA remodeling
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