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Evaluation of Cardiac Systolic Function in Cirrhotic Patients Undergoing Liver Transplantation
Roya Sattarzadeh-Badkoubeh1, Babak Geraiely1, Mohssen Nassiri-Toosi2
1Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Cirrhotic patients often have cardiac dysfunction before liver transplantation. Left ventricular systolic time interval and Tei indices may help evaluate systolic function in these patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Cirrhosis is associated with cardiovascular disturbances.
- Cardiac dysfunction can worsen after liver transplantation, increasing mortality risk.
Purpose of the Study:
- To assess systolic cardiac indices for detecting left and right ventricular systolic dysfunction in cirrhotic patients awaiting liver transplantation.
- To identify reliable echocardiographic indices for evaluating cardiac function in this population.
Main Methods:
- Echocardiography (2D, Color Flow Doppler, Tissue Doppler) was performed on 81 cirrhotic patients and 32 healthy controls.
- Measurements included atrial/ventricular dimensions, ejection fraction, stroke volume, and various systolic time intervals and velocities.
- Analysis focused on identifying differences between cirrhotic patients and controls and assessing index reliability.
Main Results:
- Cirrhotic patients showed significantly higher left atrial/area, right atrial area, LV end-diastolic volume, and RV diameter compared to controls.
- Several systolic indices, including LV ejection fraction and RV systolic velocities, were paradoxically higher in cirrhotic patients.
- Isovolumic contraction time, LV systolic time interval, and Tei indices were higher in cirrhotic patients, indicating potential systolic dysfunction.
Conclusions:
- Many cirrhotic patients exhibit cardiovascular disturbances, with some systolic indices being load-dependent and unreliable.
- Left ventricular systolic time interval and Tei indices of both ventricles appear to be valuable for assessing systolic function in cirrhotic patients.
- These indices may aid in pre-transplant risk stratification and management of cardiac complications.
Abstract:
We assessed different systolic cardiac indices to detect left and right ventricular systolic dysfunction in cirrhotic patients before liver transplantation. Between 2010-2011, 81 consecutive individuals with confirmed hepatic cirrhosis who were a candidate for liver transplantation were enrolled in this study. A total of 32 age and sex matched healthy volunteers were also selected as the control group. A detailed two-dimensional, Color Flow Doppler, and Tissue Doppler echocardiography were performed in all patients and control participants. Left atrial diameter and area, right atrial area, left ventricular end diastolic volume, and basal right ventricular diameter were significantly higher in the cirrhotic group (P<0.05). Left ventricular ejection fraction, stroke volume, left ventricular outflow tract velocity time integral and tricuspid annular plane systolic excursion were also higher in the cirrhotic group (P<0.05). Peak systolic velocities of tricuspid annulus, basal segment of RV free wall and basal segment of septal wall, peak strains of basal and mid portions of septal wall, mid portion of lateral wall and peak strain rates of basal and mid portions of septal and lateral walls were higher significantly in cirrhotic group, as well (P<0.05). Isovolumic contraction time, LV systolic time interval and Tei indexes of left and right ventricles which all are representatives of systolic dysfunction were higher in cirrhosis. Peak systolic velocity of a mid-segment of the lateral wall was lower in the cirrhotic group (P<0.05) as well. Most of the cirrhotic patients display signs of cardiovascular disturbances that become more manifest following exposure to stresses such as transplantation. Cardiac failure is an important cause of death following liver transplantation. Because of the load dependency we cannot use most of the cardiac systolic indices for evaluation of systolic function in cirrhotic patients. Thus, we suggest that LV systolic time interval and Tei indices of left and right ventricles might be useful indices in the evaluation of systolic function in cirrhotic patients.
