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Evaluating Diastolic Dysfunction as an Indicator of Cirrhotic Cardiomyopathy in Decompensated Chronic Liver Disease
Prashant Kumar1, Amish Shikoh2, Neha Rani3
1Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, IND.
Insights
Left ventricular diastolic dysfunction (LVDD) is a frequent complication in decompensated chronic liver disease (DCLD). Early detection of LVDD through serum bilirubin and QTc interval monitoring can improve survival rates in cirrhotic cardiomyopathy patients.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Cirrhotic cardiomyopathy (CCM) is a common complication in decompensated chronic liver disease (DCLD) patients.
- The compromised life expectancy in DCLD necessitates understanding CCM's early indicators.
Purpose of the Study:
- To determine the prevalence of diastolic dysfunction in chronic liver disease patients.
- To establish diagnostic criteria for left ventricular diastolic dysfunction (LVDD) in cirrhotic patients.
- To evaluate LVDD as an early indicator of CCM.
Main Methods:
- A 18-month hospital-based, cross-sectional study of 158 DCLD patients.
- Clinical and radiological diagnosis of chronic liver disease.
- Regression analysis to identify predictors of diastolic dysfunction (DD).
Main Results:
- Age (31-60 years) and elevated serum bilirubin (>2mg/dL) are significant factors for LVDD (p<0.0001).
- Child-Turcotte-Pugh score (p=0.0180) and prolonged QTc interval (p<0.0001) correlate significantly with LVDD.
- ROC analysis showed an AUC of 0.64 for predicting LVDD.
Conclusions:
- LVDD serves as an early indicator of liver cirrhosis severity in DCLD.
- Prolonged QTc in DCLD patients may increase the risk of ventricular arrhythmias.
- Regular monitoring of serum bilirubin and ECG (QTc interval) is recommended for early detection and improved survival in DCLD patients.
Background:
The clinical syndrome of cirrhotic cardiomyopathy (CCM) occurs quite frequently in decompensated chronic liver disease (DCLD) patients without any prior incidence. The compromised life expectancy under such conditions was the key that prompted us to conduct this study.
Purpose:
This study was planned to study the prevalence of diastolic dysfunction in chronic liver disease patients, to understand the diagnostic criteria of left ventricular diastolic dysfunction (LVDD) in cirrhotic patients, and to evaluate its occurrence as an early indicator of CCM.
Methods:
A hospital-based, cross-sectional study was conducted on 158 patients, admitted to the Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, India, who conformed to our criteria for inclusion and exclusion. The study period was for 18 months. The subjects were clinically and radiologically diagnosed with chronic liver disease. Regression analysis for variables was performed to score the effects of potential variables with outcomes for diastolic dysfunction (DD) prediction.
Results:
Out of 158 patients, 116 belonged to the age group of 31-60 years, pronouncing age to be a significant factor for LVDD. Fifty-three subjects had serum bilirubin levels >2mg/dL and we found serum bilirubin levels to bear a significant correlation with LVDD by exhibiting a p-value <0.0001. Both the Child-Turcotte-Pugh score class (p-value=0.0180) and QTc (p-value <0.0001) bear significant correlation with the development of LVDD, which is also evident from their area under the curve (AUC) values of 0.64 in the receiver operating characteristic (ROC) curve.
Conclusion:
Our study concludes that LVDD is an early indicator for assessing the severity of liver cirrhosis in DCLD. The correlation of DCLD with prolonged QTc could predispose patients with DCLD to ventricular arrhythmias. Hence, such patients should undergo serum bilirubin tests, and electrocardiographic checks at regular intervals for early detection, to increase their overall survival rates.
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