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Prevalence and prognostic value of cirrhotic cardiomyopathy as defined according to the proposed new classification

Maurizio Cesari1, Anna Chiara Frigo2, Salvatore Piano1

  • 1Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Italy.

Clinical and Experimental Hepatology
|October 29, 2021
PubMed

Insights

Cirrhotic cardiomyopathy (CCM) affects 29% of patients, primarily due to altered global longitudinal strain (GLS). However, current criteria lack prognostic value for clinical management, suggesting a need for revised diagnostic approaches.

Area of Science:

  • Cardiology
  • Hepatology
  • Echocardiography

Background:

  • Cirrhotic cardiomyopathy (CCM) is a complex cardiac dysfunction in liver cirrhosis.
  • The prevalence and prognostic significance of CCM, based on recent 2019 criteria, remain largely uncharacterized.
  • Understanding CCM is crucial for managing cirrhotic patients, who often have co-existing cardiovascular issues.

Purpose of the Study:

  • To determine the prevalence of cirrhotic cardiomyopathy (CCM) using the 2019 core criteria.
  • To evaluate the prognostic relevance of CCM in a large cohort of cirrhotic patients.
  • To assess the utility of current CCM diagnostic criteria in clinical management.

Main Methods:

  • Retrospective analysis of 162 cirrhotic patients followed for at least 6 years.
  • Standard Doppler echocardiography and speckle tracking analysis were performed.
  • Assessment included left ventricular (LV) geometry, systolic/diastolic function, global longitudinal strain (GLS), and hemodynamic parameters.

Main Results:

  • Echocardiographic analysis was feasible in 83 patients.
  • The prevalence of CCM was 29%, primarily driven by altered resting global longitudinal strain (GLS).
  • No significant differences in baseline characteristics or long-term outcomes (death, hepatorenal syndrome) were observed between patients with and without CCM.

Conclusions:

  • The 2019 criteria for CCM identify a significant prevalence (29%) but lack prognostic relevance in cirrhotic patients.
  • Current CCM diagnostic criteria, including LV ejection fraction (LVEF) assessment, appear insufficient for clinical management.
  • Modification of criteria, incorporating stress testing for cardiac contractile reserve, is proposed to improve prognostic accuracy.
Abstract

Keywords:
cirrhosiscirrhotic cardiomyopathydiastolic dysfunctionechocardiographysystolic function

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