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Published on: June 26, 2014
Cardiac health in patients with hepatitis B virus-related cirrhosis
Wei Yuan1, Hong-Zhou Lu2, Xue Mei1
1Department of Liver Intensive Care Unit.
Insights
Hepatitis B virus (HBV) related cirrhosis commonly impairs cardiac health, even in patients without typical heart disease symptoms. This study found impaired cardiac function and exercise tolerance worsen with liver disease severity, highlighting the need for cardiac consideration in cirrhosis management.
Area of Science:
- Hepatology
- Cardiology
- Internal Medicine
Background:
- Cirrhosis, regardless of etiology, is linked to cardiac dysfunction.
- Hepatitis B virus (HBV) infection is a common cause of nonalcoholic cirrhosis, with potential cardiac implications.
- Cardiac health in HBV-related cirrhotic patients without overt cardiac symptoms requires investigation.
Purpose of the Study:
- To noninvasively evaluate cardiac function in HBV-related cirrhotic patients.
- To assess exercise performance in this patient group.
- To identify cardiac dysfunction and its association with liver disease severity.
Main Methods:
- Recruited 79 HBV-related cirrhotic patients and 103 controls.
- Performed clinical examinations and noninvasive cardiac health evaluations.
- Investigated incidence, risk factors of cardiac dysfunction, and exercise tolerance.
Main Results:
- A correlation was found between QTc interval and Model for End-Stage Liver Disease (MELD) score (P=.018).
- 51.90% of patients met criteria for cirrhotic cardiomyopathy, with increased cardiac diastolic dysfunction (CDD) correlating with higher Child-Pugh grades (P=.004).
- Higher Child-Pugh scores predicted CDD (OR=1.662, P=.010), and both cardiac function and exercise tolerance declined with increasing liver disease severity.
Conclusions:
- Impaired cardiac health, including diastolic dysfunction, is prevalent in HBV-related cirrhotic patients.
- Cardiac factors should be integrated into the comprehensive management of cirrhosis.
- Hepatology physicians should emphasize exercise training for these patients.
Abstract:
Not only alcoholic cirrhosis related to cardiac dysfunction, cirrhosis caused by nonalcoholic etiology including hepatitis B virus (HBV) infection also related to impaired cardiac health. The aims of present study were to perform a noninvasive evaluation of cardiac function and to evaluate exercise performance in HBV related cirrhotic patients without typical symptoms of cardiac disease.Seventy-nine HBV related cirrhotic patients and 103 matched subjects without a previous history of cardiac involvement were recruited. Clinical examination and cardiac health evaluation were performed. The incidence, risk factors of cardiac dysfunction and exercise tolerance were investigated.A correlation between QTc interval and model for end-stage liver disease score (R = 0.239, P = .018) was detected, however, the connection between QTc prolongation and the severity of liver disease was uncertain. Patients with HBV related cirrhosis had a tendency toward left ventricular wall thickening (P = .007). Forty-one patients (51.90%) were in accordance with the definition of cirrhotic cardiomyopathy, and a significant increase in the incidence of cardiac diastolic dysfunction (CDD) could be found with increasing Child-Pugh grade (P = .004). HBV related cirrhotic patients with CDD had a higher level of pro-brain natriuretic peptide (P = .025), international normalized ratio (P = .010) Child-Pugh score (P = .020), and a higher proportion of ascites (P < .001). The higher Child-Pugh score (odds ratio = 1.662, P = .010) was an independent diagnostic predictor of CDD. The cardiac depression and exercise tolerance also got worse with increasing Child-Pugh score (P < .001).Impaired cardiac health was common in HBV related cirrhotic patients. Cardiogenic factors must be carefully considered in the integral therapy of cirrhosis. Hepatology physicians should lay emphasis on exercise training in daily life.
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