Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis
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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.
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.
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.
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.
KeywordsCardiomyopathy Diastolic dysfunction Cirrhosis Survival
Left ventricular diastolic dysfunction
Spontaneous bacterial peritonitis
Brain natriuretic peptide
Corrected QT interval
Tissue Doppler imaging
Mean arterial pressure
Left ventricular end diastolic diameter
- LAvol in.
Left atrium volume index
- LVEF %
Left ventricular ejection fraction %
Systemic vascular resistance index
Isovolumetric relaxation time
Pulmonary artery systolic pressure
Model of end-stage liver disease
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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