Abstract
Presence of cardiac dysfunction has been associated with an unfavorable prognosis in patients with liver cirrhosis. In the present study, 92 consecutive, newly-diagnosed patients with liver cirrhosis were prospectively evaluated. Liver disease was graded according to the modified Child-Turcotte-Pugh (CTP) score whereas left ventricular diastolic function was assessed by Doppler-echocardiography and graded (Stage 0 to 4) according to current guidelines. Overall, DD was diagnosed in 55/92 (59.8%) patients [DD-stage-1: 36/92 (39.1%), DD-stage-2: 19/92 (20.6%)]. Prevalence of DD-stage-1 among the different stages of liver cirrhosis was: CTP-class A: 11/29 (37.9%), B: 15/39 (38.5%), C: 10/24 (41.6%), (P > 0.05 in all comparisons), whereas for DD-stage-2 the corresponding proportions were CTP-class A: 3/29 (10.3%), B: 5/39 (12.8%), C: 11/24 (45.8%), (P = 0.0009 between CTP-class C versus A and B). Age > 53 years (Odd's Ratio [OR]: 4.2; 95% confidence interval [CI]: 1.5–12.1) and CTP-class C (OR: 4.6; 95% CI: 1.1–20) could independently predict DD. No relation between presence of DD and the etiology of the liver disease was found. We conclude that DD is a common feature in liver cirrhosis. DD-stage-1 is fairly prevalent among all CTP-classes whereas DD-stage-2 seems to be characteristic of the advanced liver disease (CTP-class C). A high level of awareness for the presence of the syndrome is required, especially if cirrhotic patients are CTP-class C and/or of older age.
Highlights
Hemodynamic alterations characterized by increased cardiac output and decreased systemic vascular resistances are well known to be extremely common among patients with liver cirrhosis [1, 2]
Many aspects of cardiac structure and function have been described to be abnormal in cirrhosis including histological and structural alterations, systolic and diastolic dysfunction, and electrophysiological changes [16, 17]
Diastolic dysfunction (DD) is known to be associated with an aggravation in the clinical course, probably by playing a role in the pathogenesis of sodium and fluid retention [16] and leading to a slower mobilization of ascites
Summary
Hemodynamic alterations characterized by increased cardiac output and decreased systemic vascular resistances are well known to be extremely common among patients with liver cirrhosis [1, 2]. During the past 2 decades, various observations have indicated the presence of a latent cardiac dysfunction which includes a combination of blunted myocardial contractility, altered diastolic relaxation, and electrophysiological abnormalities, all occurring in the absence of a concomitant heart disease [3,4,5]. This clinical entity, called “cirrhotic cardiomyopathy,” has been repeatedly shown to have a negative prognostic impact, especially on the outcome of invasive procedures such as surgery, transjugular intrahepatic portosystemic shunt insertion (TIPS), and liver transplantation [6,7,8,9]. According to current recommendations, DD can be echocardiographically graded in four stages [14], and to date the prevalence of the different stages of DD among patients with cirrhosis remains unknown
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