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Increased left ventricular mass in pre-liver transplantation cirrhotic patients
Marina De Marco1, Marcello Chinali, Carmela Romano
1Echocardiography Laboratory, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy.
Insights
Patients with severe liver disease exhibit increased left ventricular mass (LVM) beyond compensatory needs, indicating subclinical heart dysfunction. This cardiac remodeling suggests an adaptation to hemodynamic overload in liver disease.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Severe liver disease, particularly cirrhosis, is linked to cardiac abnormalities.
- Understanding cardiac adaptation to hemodynamic overload in liver dysfunction is crucial.
Purpose of the Study:
- To assess the prevalence of cardiac geometry and function abnormalities in cirrhotic patients.
- To determine if these abnormalities represent cardiac adaptation to hemodynamic overload.
Main Methods:
- Doppler echocardiography was performed on 70 cirrhotic patients and 70 controls.
- Left ventricular mass (LVM) was measured and compared to predicted values based on hemodynamic load.
- An observed/predicted LVM ratio >128% indicated inappropriately high LVM.
Main Results:
- Cirrhotic patients showed higher LVM index and an increased observed/predicted LVM ratio.
- The prevalence of inappropriately high LVM was nearly threefold higher in cirrhotic patients.
- Mild impairment of left ventricular systolic function was observed in cirrhotic patients.
Conclusions:
- Cirrhotic patients exhibit left ventricular mass exceeding compensatory requirements for hemodynamic overload.
- These findings suggest subclinical systolic dysfunction in severe liver disease.
Objective:
Severe liver disease is associated with abnormalities in cardiac geometry and function. We aimed to assess the prevalence of these abnormalities and to determine if they represent an adaptation of the heart to the haemodynamic overload associated with liver dysfunction.
Methods:
Seventy cirrhotic patients underwent standard Doppler echocardiography, as a screening evaluation for liver transplantation, and were compared with 70 normal subjects matched for age and sex. The values of echocardiographically measured left ventricular mass (LVM) were compared with those predicted from individual haemodynamic load, sex and height, which represent the compensatory values. LVM was considered inappropriately high when the observed/predicted LVM ratio was >128%.
Results:
Cirrhotic patients had higher LVM index (40.6 +/- 11.2 vs. 36.3 +/- 7.7 g/m; P = 0.009)), similar values of ejection fraction, but lower intrinsic wall mechanics (P < 0.01) compared to controls. The observed/predicted LVM ratio was also significantly increased (117.7 +/- 30.2 vs. 106.5 +/- 16.8%; P < 0.01) and prevalence of inappropriate LVM was almost three-fold higher in cirrhotic patients (27.7 vs. 10.0%; P < 0.05) than in controls. Cirrhotic patients also presented mild impairment of left ventricular systolic function, documented by lower values of midwall shortening.
Conclusions:
Patients with severe liver disease have LVM values exceeding the compensatory needs to sustain haemodynamic overload, associated with subclinical systolic dysfunction.
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