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Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis

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Abstract

Background and purpose

Left ventricular diastolic dysfunction (LVDD) constitutes the prominent characteristic of cirrhotic cardiomyopathy, but its relevance on the clinical course of cirrhotic patients has not been clearly defined. The aim of the study was to evaluate the relationship of LVDD with the severity and etiology of liver disease and to investigate whether it affects the outcome of cirrhotic patients.

Methods

Cardiac function of 45 cirrhotics was studied by a tissue Doppler imaging echocardiography. Diagnosis of LVDD was made according to the latest guidelines of the American Society of Echocardiography. All patients were followed up for a period of 2 years. Death or liver transplantation was the endpoint of the study.

Results

LVDD was found in 17 (38 %) of 45 patients. Its presence was not found to be associated with the etiology and stage of cirrhosis, but its severity was directly correlated with the Child-Pugh score. At the end of follow-up, 14 patients had died; 9 had LVDD (9/17, 53 %) and 5 had not (5/28, 18 %). Patients who died at the beginning of observation period had a higher Child-Pugh and MELD score, higher BNP, lower albumin and more prolonged QTc. On Kaplan-Meier analysis, patients with LVDD had statistically significantly worse prognosis compared to those without (p = 0.013, log rank: 5.495). Low albumin values (p = 0.003) and presence of LVDD (p = 0.017) were independent predictive factors of mortality.

Conclusions

LVDD is a common complication of cirrhosis. As its development seems to be related to a worse prognosis, patients with LVDD must be under a strict follow-up.

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Abbreviations

LVDD:

Left ventricular diastolic dysfunction

HRS:

Hepatorenal syndrome

CC:

Cirrhotic cardiomyopathy

SBP:

Spontaneous bacterial peritonitis

BNP:

Brain natriuretic peptide

ECG:

Electrocardiograph

QTc:

Corrected QT interval

PW:

Pulse wave

TDI:

Tissue Doppler imaging

HR:

Heart rate

MAP:

Mean arterial pressure

LVEDD:

Left ventricular end diastolic diameter

LAvol in.:

Left atrium volume index

LVEF %:

Left ventricular ejection fraction  %

CI:

Cardiac index

SVRI:

Systemic vascular resistance index

DT:

Deceleration time

IVRT:

Isovolumetric relaxation time

PASP:

Pulmonary artery systolic pressure

MELD:

Model of end-stage liver disease

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Acknowledgements

Guarantor of the study: Prof. S.D. Ladas. D.Karagiannakis planned and designed the study, recruited the pool of patients, analyzed the data and wrote the report. G. Anastasiadis was responsible for the cardiovascular assessment that was performed on patients. Assistant Prof. J. Vlachogiannakos participated in the study design and interpretation of the data, and he was responsible for the statistical analysis. Prof. I. Vafiadis-Zouboulis participated in the interpretation of the data.

Compliance with ethical requirements and Conflict of interest

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. Dimitrios Karagiannakis, Jiannis Vlachogiannakos, Georgios Anastasiadis, Irini Vafiadis-Zouboulis and Spiros D. Ladas declare that they have no conflict of interest.

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Authors and Affiliations

  1. Academic Department of Gastroenterology, Medical School of Athens, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece

    Dimitrios S. Karagiannakis, Jiannis Vlachogiannakos, Irini Vafiadis-Zouboulis & Spiros D. Ladas

  2. Department of Cardiology, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece

    Georgios Anastasiadis

Authors
  1. Dimitrios S. Karagiannakis
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  2. Jiannis Vlachogiannakos
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  3. Georgios Anastasiadis
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  5. Spiros D. Ladas
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Corresponding author

Correspondence to Dimitrios S. Karagiannakis.

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Karagiannakis, D.S., Vlachogiannakos, J., Anastasiadis, G. et al. Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis. Hepatol Int 8, 588–594 (2014). https://doi.org/10.1007/s12072-014-9544-6

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  • DOI: https://doi.org/10.1007/s12072-014-9544-6

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