The Interplay between Severe Cirrhosis and Heart: A Focus on Diastolic Dysfunction

Area of Science:

• Cardiology
• Hepatology
• Internal Medicine

Background:

• Cardiovascular complications in severe cirrhosis pose diagnostic and prognostic challenges.
• Understanding the link between liver disease severity, portal hypertension, and cardiac function is crucial.

Purpose of the Study:

• To assess the relationship between liver disease severity and portal hypertension with the prevalence and burden of diastolic dysfunction.
• To evaluate echocardiographic parameters of diastolic function in patients with varying degrees of hepatic cirrhosis.

Main Methods:

• Prospective enrollment of 102 patients with hepatic cirrhosis, stratified by Child-Pugh criteria into non-severe (A/B) and severe (C) groups.
• Abdominal ultrasound to measure portal vein and spleen diameters.
• Echocardiography to assess left ventricular systolic function (ejection fraction) and diastolic function (E/Em ratio, E/Vp ratio, indexed left atrial volume).

Main Results:

• Diastolic dysfunction was prevalent in 55% of cirrhotic patients.
• Severe cirrhosis (Child-Pugh C) showed a significantly higher burden of diastolic dysfunction compared to non-severe cirrhosis (Child-Pugh A/B).
• Elevated E/Vp ratio, indexed LA volume, and E/Em ratio in severe cirrhosis correlated with increased portal vein and spleen diameters, indicating greater portal hypertension.

Conclusions:

• Diastolic dysfunction is a significant finding in liver cirrhosis, increasing with disease severity.
• Portal hypertension, evidenced by enlarged portal vein and spleen, is associated with a greater burden of diastolic dysfunction.
• Echocardiographic parameters effectively quantify diastolic dysfunction and its correlation with portal hypertension in cirrhosis.