Cirrhotic Cardiomyopathy: Proportion and Correlation with Liver Fibrosis Severity

Cirrhotic cardiomyopathy is characterized by an impaired systolic response to stress, diastolic dysfunction, and electrophysiological abnormalities, without underlying structural heart disease. Left ventricular diastolic dysfunction (LVDD) is the most common manifestation found in cirrhotic cardiomyopathy. Previous studies reported its correlation with a higher Child-Turcotte-Pugh (CTP) score in late-stage cirrhosis. To date, no studies have evaluated the correlation between liver fibrosis and LVDD parameters. This study aims to evaluate the correlation between liver fibrosis and LVDD parameters.

We conducted a cross-sectional study on liver cirrhosis patients without a history of cardiac disease. Subjects were recruited consecutively from the Hepatobiliary Outpatient Clinic and Internal Medicine Inpatient Unit at Cipto Mangunkusumo National General Hospital. A total of 92 patients underwent 2-dimensional echocardiography with tissue Doppler imaging, transient elastography, and laboratory tests for routine hematology, ALT, and AST.

A total of 27.2% of subjects had diastolic dysfunction, and 37% had normal diastolic function with an increased left atrial volume index. APRI and FIB-4 showed a positive correlation with left atrial volume index (r = 0.302; p = 0.003 vs r = 0.401; p < 0.0001, respectively). FIB-4 demonstrated a fair performance in estimating increased left atrial volume index (AUC 0.746; 95% CI 0.646-0.846), with a cut-off point of 4.38.

Diastolic dysfunction is the most common early manifestation found in cirrhotic cardiomyopathy. Liver fibrosis, assessed by APRI and FIB-4, was positively correlated with increased left atrial volume index.