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CRITERIA FOR DIAGNOSIS OF CARDIOMYOPATHY IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS BEFORE THE ONSET OF HEART DAMAGE
M Abrahamovych1, S Tolopko1, M Farmaha1
1Danylo Halytsky Lviv National Medical University; Institute of Cell Biology of National Academy of Sciences of Ukraine.
Insights
Early diagnosis of cirrhotic cardiomyopathy in alcoholic liver cirrhosis patients is possible. Biomarkers like natriuretic peptide and QT interval predict heart damage before symptoms appear, aiding timely intervention.
Area of Science:
- Cardiology
- Hepatology
- Biomarkers
Background:
- Alcoholic liver cirrhosis frequently coexists with cardiac dysfunction.
- Cirrhotic cardiomyopathy (CCM) often presents asymptomatically, delaying diagnosis and treatment.
- Early identification of CCM is crucial for managing patients with alcoholic liver cirrhosis.
Purpose of the Study:
- To establish diagnostic criteria for asymptomatic cirrhotic cardiomyopathy in alcoholic liver cirrhosis patients.
- To identify reliable biomarkers for detecting early-stage CCM before clinical manifestation.
- To differentiate between patients with and without CCM, and between symptomatic and asymptomatic CCM.
Main Methods:
- Echocardiography to assess left ventricular diastolic and systolic functions.
- Blood plasma analysis for natriuretic peptide levels.
- Electrocardiography (ECG) to measure QT interval duration.
- Evaluation of myocardial functional capacity index and cardiac chamber volumes.
Main Results:
- Patients with CCM, both symptomatic and asymptomatic, exhibit impaired diastolic and systolic functions.
- Asymptomatic CCM patients show significantly lower natriuretic peptide levels, fewer extrasystoles, and preserved ejection fraction compared to symptomatic patients.
- Specific biomarkers including natriuretic peptide, QT interval parameters, and early filling velocities demonstrate high accuracy, sensitivity, and specificity for diagnosing asymptomatic CCM.
Conclusions:
- Diagnostic criteria for asymptomatic cirrhotic cardiomyopathy can be established using a combination of biomarkers.
- Natriuretic peptide levels, QT interval, and echocardiographic parameters are valuable for early CCM detection in alcoholic liver cirrhosis.
- These findings enable diagnosis of CCM prior to the onset of clinical symptoms, facilitating proactive management.
Abstract:
The article clarifies the diagnostic criteria for syntropic heart damage - cardiomyopathy in patients with Alcoholic Liver Cirrhosis before the clinical signs of heart damage appear. As a result of the examination of 64 patients with Cirrhotic Cardiomyopathy, of which 51 patients were identified without clinical signs of heart damage (study group 1), 13 patients with clinical signsof heart damage (study group 2), and 23 patients without cardiomyopathy (comparison group), it was found that: 1) in patients with Cirrhotic Cardiomyopathy (both with and without manifestation of clinical signs of heart damage), there is a violation of its diastolic and systolic functions, which can be diagnosed by change of parameters of the natriuretic peptide in the blood plasma, the frequency of supraventricular premature beats and premature ventricular contractions, the duration of the QT interval, the maximum blood flow velocity in the phase of early filling of the left ventricle and the left atrium systole, their ratio, the myocardial functional capacity index, end-diastolic and end-systolic volumes of the left ventricle and left atrium; 2) in patients with Cirrhotic Cardiomyopathy without clinical manifestations, significantly lower (p<0.05) indicators of the natriuretic peptide, the frequency ofextrasystoles, the end-diastolic and end-systolic volumes of the left ventricle and left atrium, and a higher rate of ejection fraction of the left ventricle were revealed than in patients with the clinical manifestation of this disease; 3) we found high accuracy, specificity and sensitivity of the indicators of the natriuretic peptide, the QT interval (maximum, maximum corrected, average, mid-corrected), maximum blood flow velocity in the phase of early filling of the left ventricle and of the systole of the left atrium, their ratio, as well as the myocardial functional capacity index in patients with alcoholic liver cirrhosis with an asymptomatic course of cardiomyopathy that allows to use them to verify the diagnosis of Cirrhotic Cardiomyopathy until the first clinical signs of myocardial damage appear.
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