Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging
Konstantin Kazankov1, Peter Holland-Fischer, Niels H Andersen
1Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Skejby, Denmark. konka@dadlnet.dk
Insights
Cirrhotic cardiomyopathy causes significant systolic and diastolic myocardial dysfunction at rest, detectable by tissue Doppler imaging. This confirms a distinct cardiac condition in cirrhosis patients.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Cirrhotic cardiomyopathy is often considered latent cardiac failure.
- Myocardial dysfunction in cirrhosis at rest requires further investigation.
Purpose of the Study:
- To quantify resting left ventricular function in cirrhosis patients using tissue Doppler imaging.
- To correlate cardiac function findings with liver status and cirrhosis etiology.
Main Methods:
- Included 44 cirrhosis patients and 23 healthy controls.
- Utilized conventional echocardiography and tissue Doppler imaging for systolic and diastolic function assessment.
- Quantified liver function via galactose elimination capacity and clinical stage using Child-Pugh and MELD scores.
Main Results:
- Cirrhosis patients exhibited compromised systolic and diastolic myocardial function at rest.
- Reduced left ventricular ejection fraction, peak systolic tissue velocity, and systolic strain rate were observed in patients.
- 54% of patients displayed diastolic dysfunction, with various patterns including impaired relaxation and pseudonormal filling.
Conclusions:
- Tissue Doppler imaging revealed significant resting systolic and diastolic myocardial dysfunction in cirrhosis patients.
- These findings support the existence of a distinct cirrhotic cardiomyopathy.
- Echocardiographic findings were not associated with the etiology of cirrhosis.
Background:
Cirrhotic cardiomyopathy is described as latent cardiac failure. However, it remains to be investigated whether the myocardial dysfunction is present even at rest.
Aims:
The aim of the present study was to quantify left ventricular function at rest by means of tissue Doppler imaging in patients with cirrhosis and relate the findings to liver status and cirrhosis aetiology.
Methods:
Forty-four consecutive patients and 23 age-matched healthy controls were included. Conventional echocardiographic- and tissue Doppler-derived indices of systolic and diastolic function were obtained. Liver function was quantified by the galactose elimination capacity and clinical stage by the Child-Pugh and MELD scores.
Results:
Both systolic and diastolic myocardial functions were compromised in the patients at rest. Left ventricular ejection fraction (56.4 ± 6.1 vs. 59.9 ± 3.9%, P<0.02), mean peak systolic tissue velocity (4.6 ± 0.9 vs. 5.6 ± 0.7 cm/s, P<0.001) and mean systolic strain rate (-1.23 ± 0.19 vs. -1.5 ± 0.14/s, P<0.001) were all reduced in cirrhosis patients. Thirty-four patients (54%) had diastolic dysfunction, 11 had impaired diastolic relaxation pattern (25%), 12 had the more severe pseudonormal filling pattern (27%) and one had restrictive filling or severe diastolic dysfunction (2%). None of the echocardiographic findings were related to the cirrhosis aetiology.
Conclusion:
Tissue Doppler imaging during rest detected substantial systolic and diastolic myocardial dysfunction in cirrhotic patients. This supports the existence of a distinct cirrhotic cardiomyopathy.
