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Ventricular function in cirrhosis and portasystemic shunt: a two-dimensional echocardiographic study
H Keller1, V Bezjak, B Stegaru
1I. Medizinische Klinik, Klinikum Mannheim der Universität Heidelberg, Federal Republic of Germany.
Insights
Chronic portasystemic shunts in cirrhosis patients did not significantly strain the heart. Echocardiographic studies show normal systolic function despite hemodynamic changes, unlike acute shunt effects.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Advanced liver disease is associated with cardiovascular alterations, termed cirrhotic cardiomyopathy.
- Cirrhosis patients face increased risk of circulatory deterioration under stress.
- Portacaval shunts redirect blood flow, potentially straining the heart.
Purpose of the Study:
- To assess the hemodynamic impact of chronic portasystemic shunts on cardiac function in cirrhosis patients.
- To compare the effects of chronic shunts versus acute shunt opening on the heart.
Main Methods:
- Two-dimensional echocardiography was used.
- Studied 30 patients with cirrhosis and 20 with chronic portasystemic shunts (16-156 months).
Main Results:
- Chronic shunts altered hemodynamics, increasing left ventricular end-diastolic and end-systolic volumes.
- Cardiac output remained high due to increased stroke volume, despite decreased heart rate.
- Systolic ventricular performance parameters were normal; chronic shunts showed no significant cardiac strain.
Conclusions:
- Chronic portasystemic shunts in cirrhosis patients do not impose a clinically significant strain on the heart.
- Hemodynamic changes observed with chronic shunts differ from the acute effects of portacaval shunt opening.
Abstract:
Cardiovascular alterations such as increased heart rate, high cardiac output, reduced systemic vascular resistance, and in most of the cases, increased contractility parameters have been recognized in patients with advanced liver disease. Some investigators define a cirrhotic cardiomyopathy as a hyperdynamic failure of the heart. Consequently, in patients with cirrhosis, the risk of developing further circulatory deterioration may be increased in situations which stress the cardiovascular system. After opening a portocaval shunt, it is expected that a large amount of blood will be distributed from the splanchnic to the pulmonary circulation and put a strain on the heart. This two-dimensional echocardiographic study was made in 30 patients with cirrhosis and in 20 patients who were chronically treated (range: 16 to 156 months) with portasystemic shunt for prevention of hemorrhage from esophageal variceal bleeding. Patients with portasystemic shunts revealed a change in hemodynamic pattern. There was a significant increase in the left ventricular end-diastolic volume index and also a slight increase in the left ventricular end-systolic index. Cardiac output remained high despite a significant decrease in heart rate due to an elevated left ventricular stroke volume index. The parameters of systolic ventricular performance were normal. In contrast to the acute opening of the portacaval shunt, the chronic shunt volume put no strain of clinical significance on the heart.