Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
ANTIALDOSTERONE THERAPY IN LIVER CIRRHOSIS: A ROLE FOR PREVENTION OF CIRROTHIC CARDIOMIOPATHY?
P. Ventura1*, M. Ferrari1, A.C. Nuzzo2, F. Nascimbeni1, E. Romagnoli1, R. Rossi2, V. Moriondo1, A. Vegetti1, M.G. Modena2, A. Pietrangelo1
1Dept. of Medicines and Medical Specialities, 2Dept. of Urgency and Emergency, University of Modena and Reggio Emilia, Modena, Italy. *firstname.lastname@example.org
Background/aims: Cirrhotic cardiomiopathy (CC) comprises a constellation of cardiac abnormalities associated with disease progression and due to multiple pathogenetic mechanisms; CC plays a major role in cardiac dysfunction complicating OLT or TIPPS placement. Our work aims at assessing the different role of possible CC-associated factors.
Materials and methods: 50 liver cirrhosis(LC) (no hemochromatosis, cardiopulmonary or alcohol-related disease) and 17 ECA patients were assessed for cardiac parameters (EF, Ea, TAPSE, E/Aratio and Deceleration time (DT), QTc interval); Child-Pugh score; ANF ,BNF, Epinephrine (E), Norepinephrine(NE), PRA, Aldosterone(A), nitric oxide(NO), IL-6 and TNF-a, PIIINP plasma levels; APRI, Fibroscore, 4-parameter scores; drugs history.
Results: We observed a significant prevalence of diastolic dysfunction in LC group (50% of patients had abnormal E/A ratio, 62% abnormal DT) with a higher prevalence in advanced disease (100% and 92 % of Child C patients had abnormal E/A ratio and DT, respectively). Prolonged QT (pQT) was present in 19 LC patients (38%) vs. 1 (6.25%) in ECA subjects (p< .001). At univariate analysis, diastolic dysfunction indices (abnormal DT and E/A ratio) resulted significantly related to NO, TNF-alfa, NE, E , A , PRA, ANP , BNP, PIIINP plasma levels, and Fibroscore and 4-parameters fibrosis scores. A significant correlation between pQT interval and Child score, duration of disease (years), plasma levels of TNF-a, A, ANP, BNP, PIIINP and Fibroscore and 4-parameters scores was also present. E/A ratio, DT and pQT resulted significantly inversely related to antialdosterone therapy exposition (AUC of time x dose). Table 1
| ||beta ||SE ||OR ||95% CI ||p |
|Antialdosterone exposition ||-.539 ||.137 ||0.66 ||0.43-0.78 ||.011 |
|Child Score ||.621 ||.292 ||1.35 ||1.26-2.13 ||.019 |
|Aldosterone ||.728 ||.325 ||1.26 ||1.15-3.58 ||.026 |
|PIIINP ||.345 ||.121 ||1.06 ||1.02-1.18 ||.042 |
resumes the multivariate analysis' results (stepwise multiple logistic regression) using E/A ratio < 1 as dependent variable. Similar result were obtained when using pQT as dependent variable.
Conclusions: Antialdosterone exposition results inversely and independentely related to CC abnormalities, this suggesting a possible role for optimized (in terms of dose and timing) antialdosterone therapy in prevention of CC development.