Ventriculoarterial coupling as estimated by the PWV/GLS ratio correlates with disease severity in liver cirrhosis patients

Abstract

Abstract Introduction Liver cirrhosis is characterized by vasodilation, reduced peripheral resistances and increased cardiac output. Recently, a novel parameter based on the ratio of carotid-femoral pulse wave velocity (PWV) to the absolute value of global longitudinal strain (GLS), has been proposed to estimate the relationship between left ventricle and aortic function (ventriculoarterial coupling- VAC). Purpose This study aimed to investigate the potential correlation between VAC, as estimated by the PWV/GLS ratio, and disease severity in patients with liver cirrhosis. Methods A total of 65 cirrhotic patients (mean age 59.1±8.3 years, 48 (73.8%) males) without cardiovascular disease were included in this study. PWV was calculated by dividing the estimated distance difference between the femoral and carotid arteries by the pulse transit time measured with a validated noninvasive device (simultaneous measurement with two transducers). Echocardiography was performed to determine GLS, which was calculated semi-automatically using dedicated software. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score. Results The mean PWV was 7.8 ± 1.6 m/s, mean GLS was 21.1 ± 2.7%, and mean PWV/GLS ratio was 0.38 ± 0.11. Spearman’s correlation analysis showed that both PWV and GLS were significantly correlated with MELD score (rho=-0.330, p=0.007 and rho=0.276, p=0.026, respectively), indicating that patients with higher disease severity had lower PWV and higher absolute GLS values. There was also a negative correlation between PWV and GLS (rho=-0.377, p=0.002). PWV/GLS ratio was negatively correlated with MELD score (rho=-0.354, p=0.004). In addition to MELD score, PWV/GLS ratio was significantly associated with age (rho=0.281, p=0.023) and systolic blood pressure (SBP) (rho=0.445, p<0.001). A non-significant association with stroke volume (SV) was also observed (rho=-0.207, p=0.099), suggesting that cirrhotic patients with reduced afterload and increased cardiac output had lower values of the ventriculoarterial coupling index. Multivariate linear models confirmed the robustness of the association between PWV/GLS ratio and disease severity even after accounting for age, SBP, and SV (p=0.047). Conclusions Our findings suggest that the PWV/GLS ratio is reduced in cirrhotic patients with more severe disease. This association remains significant even after controlling for age, systolic blood pressure, and stroke volume, indicating that PWV/GLS ratio may serve as an early marker of cardiovascular dysfunction in patients with liver cirrhosis.Figure 1Table 1