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Development of Liver-Heart Score for Early Detection of Myocardial Contractile Dysfunction in Cirrhosis by Strain
Marcel Razpotnik1,2, Simona Bota2, Philipp Wimmer3
1Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, Berlin, Germany.
Insights
The Liver-heart score effectively identifies cirrhotic cardiomyopathy by assessing myocardial dysfunction. This scoring system aids in risk stratification for patients with liver cirrhosis, improving patient outcomes.
Area of Science:
- Cardiology
- Hepatology
- Medical Diagnostics
Background:
- Cirrhotic cardiomyopathy presents as myocardial dysfunction in cirrhosis patients without other cardiac conditions.
- Global longitudinal strain is a key marker for myocardial dysfunction in cirrhotic cardiomyopathy.
- Accurate risk stratification is crucial for managing cirrhotic cardiomyopathy.
Purpose of the Study:
- To develop and validate a scoring system for identifying patients at high risk of reduced global longitudinal strain.
- To establish a tool for improved risk stratification in cirrhotic cardiomyopathy.
Main Methods:
- Prospective recruitment of cirrhosis patients for training and validation cohorts.
- Comprehensive hepatological and cardiological evaluations, including strain echocardiography.
- Logistic regression analysis to identify independent predictors of myocardial dysfunction.
Main Results:
- The Liver-heart score, incorporating BMI, CAP, and age, demonstrated high accuracy (AUC-ROC 0.84-0.83).
- Independent predictors identified: BMI ≥ 28 kg/m² (OR 7.02), CAP > 260 dB/m (OR 8.53), and age > 57 years (OR 4.68).
- A score of 5 points correlated with increased 2-year and overall mortality.
Conclusions:
- The Liver-heart score accurately rules out reduced myocardial contractility in cirrhotic patients.
- This score serves as a valuable tool for risk stratification in cirrhotic cardiomyopathy.
Aim:
Cirrhotic cardiomyopathy is characterised by myocardial dysfunction in patients with cirrhosis in the absence of other cardiac conditions. We aimed to develop and validate a scoring system to identify patients at high risk for reduced global longitudinal strain, a newly proposed marker of myocardial dysfunction in the updated diagnostic criteria for cirrhotic cardiomyopathy.
Methods:
Prospectively recruited patients with cirrhosis in the training and validation groups underwent identical hepatological and cardiological evaluations, including strain echocardiography. Risk factors for myocardial dysfunction were identified using logistic regression.
Results:
In a cohort of 452 consecutive patients, 278 were excluded due to non-cirrhotic cardiomyopathy or conditions potentially affecting strain measurements. The prevalence of reduced global longitudinal strain was 9.8% (13/133) in the training group and 19.5% (8/41) in the validation group. Multivariate logistic regression revealed BMI ≥ 28 kg/m2 (OR 7.02), CAP > 260 dB/m (OR 8.53), and age > 57 years (OR 4.68) as independent predictors of reduced myocardial contractility. These variables were combined and weighted based on their beta coefficients to develop the Liver-heart score (CAP > 260 dB/m [2 pts], BMI ≥ 28 kg/m2 [2 pts], age > 57 years [1 pt]). The AUC-ROC was 0.84 in the training and 0.83 in the validation cohort. A Liver-heart score of 5 points was associated with increased mortality, observed at 2 years (44.4% vs. 17.3%) and the end of the follow-up period (66.7% vs. 37.7%, HR 1.3, p < 0.01).
Conclusion:
The Liver-heart score can accurately rule out reduced myocardial contractility and may be useful for risk stratification in cirrhotic patients.
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