Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
CONTRAST-ENHANCED CARDIAC MRI REVEALS PATHOLOGICAL MYOCARDIAL ALTERATIONS - CIRRHOTIC CARDIOMYOPATHY LINKED TO PORTAL HYPERTENSION
D. Gotthardt1*, K.H. Weiss1, A. Zahn1, W. Stremmel1, P. Sauer1, D. Lossnitzer2
1Innere Medizin IV, 2Innere Medizin III, Universitätsklinik Heidelberg, Heidelberg, Germany. *email@example.com
Introduction: Portal hypertension and cirrhotic cardiomyopathy are known complications of end stage liver disease (ELD). Cardiac failure contributes to morbidity and mortality in patients, particularly after liver transplantation and TIPS. Early and more accurate diagnosis of heart disease could improve risk stratification and the management of patients at risk.
Methods: Twenty patients suffering from end stage liver disease underwent cardiac MRI for morphological, functional and tissue characterization by late contrast enhancement (LE). Based on the extent of LE, patients were dichotomized into a high or low LE group and analyzed in regard to liver, cardiocirculatory and renal functions.
Results: Cardiac MRI demonstrated hyperdynamic left ventricular function and a patchy pattern of LE of the myocardium to a variable extent (range 2-62%) in all patients. There were no significant differences in MELD, Child-Pugh score or the left ventricular ejection fraction nor in the response to dobutamin stress between the high and low LE groups. However, patients showing high LE had a higher cardiac index and alcoholic liver cirrhosis was more often the underlying disease (p< 0.05). Biomarkers of myocardial stress were elevated. And while NT-proBNP and c-Troponin-T showed no differences, PLGF and sFLT1 were lower in the high LE group. There was a higher morbidity and mortality in the high LE group in patients undergoing liver transplantation.
Conclusion: Cardiac MRI shows myocardial involvement in patients with ELD. The hyperdynamic circulation in portal hypertension may be an important factor in the development of cirrhotic cardiomyopathy. Larger prospective trials are warranted to confirm the association with severity and outcome of liver disease and to test the predictive power of MRI for patients listed for liver transplantation.