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Cardiac dysfunction in patients with cirrhosis: is the systolic component its main feature?

Maurizio Cesari1, Silvano Fasolato, Silvia Rosi

  • 1aUnit of Hepatic Emergencies and Liver Transplantation, Department of Surgery bDepartment of Medicine, University of Padova, Padova, Italy.

European Journal of Gastroenterology & Hepatology
|April 30, 2015
PubMed

Insights

Cirrhotic patients develop cardiac changes like left ventricular hypertrophy and diastolic dysfunction, independent of liver disease stage. In advanced stages, heart rate critically supports cardiac output, suggesting caution with beta-blockers.

Area of Science:

  • Cardiology
  • Hepatology
  • Internal Medicine

Background:

  • Cirrhosis leads to significant hemodynamic alterations.
  • Subclinical cardiac changes are common in liver disease.

Purpose of the Study:

  • To investigate cardiac morphological and functional changes in cirrhotic patients.
  • To correlate these changes with the stage of liver disease.

Main Methods:

  • 113 cirrhotic patients and healthy controls underwent Doppler echocardiography.
  • Assessed left ventricular geometry, systolic/diastolic function, and hemodynamics.

Main Results:

  • Cirrhotic patients exhibited reduced peripheral vascular resistance and a hyperdynamic syndrome.
  • Increased left ventricular mass and diastolic dysfunction were prevalent, predicted by age and LV mass index.
  • In refractory ascites, cardiac index and output relied solely on heart rate, failing to compensate for reduced blood pressure.

Conclusions:

  • Diastolic dysfunction in cirrhosis is linked to increased LV mass, not liver disease stage.
  • Tissue Doppler imaging is crucial for detecting diastolic dysfunction.
  • In advanced cirrhosis with ascites, cardiac function becomes critically dependent on heart rate, raising concerns about beta-blocker use.
Abstract

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