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Cardiac dysfunction in liver cirrhosis: A tissue Doppler imaging study from Egypt
Fatma Mohammad Nasr1, Amna Metwaly1, Ashraf Abdel Khalik1
1Intesive Care unit, Theodor Bilharz Research Institute, Giza, Egypt.
Insights
Liver cirrhosis patients exhibit impaired cardiac function, particularly in diastolic parameters of both ventricles. Echocardiography and tissue Doppler imaging reveal significant abnormalities in systolic and diastolic functions in these patients.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Imaging
Background:
- Liver cirrhosis is associated with cardiac abnormalities affecting patient outcomes.
- Diastolic function assessment using Tissue Doppler imaging is crucial.
- Limited data exists on right ventricular diastolic function in cirrhosis.
Purpose of the Study:
- To evaluate left and right ventricular systolic and diastolic functions in post-hepatitis C liver cirrhosis patients.
- Utilize conventional echocardiography and tissue Doppler imaging for comprehensive cardiac assessment.
Main Methods:
- Study included 75 adults: 50 with post-hepatitis C liver cirrhosis and 25 healthy controls.
- All participants underwent clinical examination, laboratory tests, abdominal ultrasonography, and echocardiography with tissue Doppler imaging.
- Assessment focused on left and right ventricular systolic and diastolic functions.
Main Results:
- Cirrhosis patients showed altered mitral and tricuspid flow patterns, including increased A wave velocity and decreased E/A ratio.
- Tissue Doppler imaging revealed significant abnormalities at the mitral and tricuspid annuli, such as increased Ea/Aa and E/Ea ratios.
- Left and right ventricular systolic and diastolic functions were significantly impaired in the liver cirrhosis group compared to controls.
Conclusions:
- Cardiovascular function evaluation is essential for all cirrhosis patients.
- Assessment is particularly critical for patients undergoing interventions that may impact hemodynamics.
Background:
Patients with liver cirrhosis suffer from various cardiac abnormalities, which may influence their outcome. Tissue Doppler recording of the mitral and tricuspid annular diastolic velocities can be used to assess diastolic function accurately. There has been very little published information regarding RV diastolic function in liver cirrhosis. This study is aimed at evaluating right and left ventricular systolic and diastolic functions in post hepatitis C liver cirrhosis patients using conventional echocardiography and tissue Doppler imaging.
Methods:
This study was conducted on 75 adults from inpatient and outpatient services of the Theodor Bilharz Research Institute (TBRI) hospital. They were divided into two groups: Group 1 included 50 patients with post hepatitis C liver cirrhosis; and Group 2 included 25 normal adults serving as a control group. All patients and normal volunteers were subjected to clinical examination, laboratory evaluation, abdominal ultrasonography and echocardiographic studies with tissue Doppler imaging for evaluation of left and right ventricular systolic and diastolic functions.
Results:
The mitral flow showed significant increase in A wave velocity, as well as DT and IVRT with a significant decrease in E/A ratio in Group 1 compared to Group 2 (P<0.01). The tricuspid flow also showed a significant increase in A wave velocity (P<0.01) and DT (P<0.05) in addition to a significant decrease in E wave velocity and E/A ratio (P<0.01) in Group 1 as compared to Group 2. At the mitral annulus, we found a significant increase in average Aa velocity, E/Ea ratio and average systolic wave velocity S, in addition to a statistically significant decrease in the average Ea velocity and average Ea/Aa (P<0.01) in Group 1 as compared to Group 2. At the tricuspid annulus, there were significant increases in the average Aa velocity (P<0.01), S velocity (P<0.01) and E/Ea (P<0.05) together with a statistically significant decrease in the average Ea/Aa and average Ea velocity (P<0.01) in Group 1 compared to Group 2.
Conclusion:
It is important to evaluate the cardiovascular function in every patient with cirrhosis, especially if the patient is a candidate for any intervention that may affect haemodynamics.