Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
PREVALENCE OF DIASTOLIC DYSFUNCTION AND OTHER SUPPORTIVE CRITERIA OF CIRRHOTIC CARDIOMYOPATHY
H. Ribeiro1*, J. Presa2, R. Margato1, S. Carvalho1, C. Ferreira1, P. Mateus1, A. Ferreira1, J.I. Moreira1
1Cardiology, 2Internal Medicine, CHTMAD, Vila Real, Portugal. *email@example.com
Introduction: Cirrhotic cardiomyopathy (CC)is the term used to describe a constellation of features indicative of abnormal heart structure and function in patients with liver cirrhosis (LC). These include systolic and diastolic dysfunction, electrophysiological changes, and macroscopic and microscopic structural changes.
Purpose: Our aim was to assess the prevalence of diastolic dysfunction and other supportive criteria of CC, in a cohort of patients with LC.
Methods: 37 patients with LC (75,7% male; mean age 62,3±9,3 years old; 64,9% with alcoholic cirrhosis and 35,1% with cirrhosis of nonalcoholic etiology; MELD score>15 in 18,9% and MELD< 15 in 18,1%) were enrolled, after excluding those with known cardiovascular risk factors (hypertension, diabetes, dislipidemia, tabagism or obesity), heart or pulmonary diseases.
We collect data from patients with LC who as part of their routine care realized blood tests (including natriuretic peptide - BNP and troponin I levels), an electrocardiogram and an echocardiogram. Left ventricular diastolic function was studied by Pulse Wave and Pulsed Doppler Tissue imaging (DTI) and the diagnosis of diastolic dysfunction (DD) was made as defined by the recent consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology.
Results: Brain natriuretic peptide (BNP>100pg/ml) was elevated in 48,4% and troponin I (TnI >0,1pg/ml) levels was increased in 5,4% LC patients. Prolonged Q-Tc interval (Q-Tc>440 mseg) was observed in 18,9%. Left atrium enlargement (LA volume>20cm2) was registered in 83,8% and increased left ventricle end diastolic diameter (LVEDd>53mm) and left ventricle end systolic diameter (LVESd>32mm) was present in 21,6% and 27,0% respectively. Increased left ventricular myocardial mass indice (LVMMI>95 g/m2 in Women and >115g/m2 in men) was identified in 67,6%.
None of the patients had depressed left ventricular ejection fraction (LVEF< 50%).
DD was detected in 24,3% of the studied patients.
Conclusions: This study showed that DD and other supportive criteria of cirrhotic cardiomyopathy are not rare in LC patients. Left cavities enlargement, ventricular hypertrophy, elevated BNP, prolonged Q-Tc, DD and conserved LVEF are the main abnormalities suggestive of CC found in patients with LC.