Clinical and Molecular Hepatology (대한간학회지)

The Korean Association for the Study of the Liver (대한간학회)
권호 표지
DOI QR코드

DOI QR Code

Cardiac diastolic dysfunction predicts poor prognosis in patients with decompensated liver cirrhosis

  • Lee, Soon Kyu (Division of Hepatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, Myeong Jun (Division of Hepatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Seok Hwan (Division of Hepatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Hyo Jun (Division of Hepatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2018.04.09
  • Accepted : 2018.06.29
  • Published : 2018.12.25
⟨ Previous Next ⟩

Abstract

Background/Aims: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC. Methods: We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival. Results: Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ${\geq}10$ (LVDD grade 2) had lower survival than patients with E/e' ratio < 10. Conclusions: The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.

Keywords

References

  1. Lim YS, Kim WR. The global impact of hepatic fibrosis and endstage liver disease. Clin Liver Dis 2008;12:733-746, vii. https://doi.org/10.1016/j.cld.2008.07.007
  2. Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol 2014;60:643-653. https://doi.org/10.1016/j.jhep.2013.09.016
  3. Jepsen P, Vilstrup H, Andersen PK. The clinical course of cirrhosis: the importance of multistate models and competing risks analysis. Hepatology 2015;62:292-302. https://doi.org/10.1002/hep.27598
  4. Timoh T, Protano MA, Wagman G, Bloom M, Vittorio TJ. A perspective on cirrhotic cardiomyopathy. Transplant Proc 2011;43:1649-1653. https://doi.org/10.1016/j.transproceed.2011.01.188
  5. Krag A, Wiest R, Albillos A, Gluud LL. The window hypothesis: haemodynamic and non-haemodynamic effects of ${\beta}$-blockers improve survival of patients with cirrhosis during a window in the disease. Gut 2012;61:967-969. https://doi.org/10.1136/gutjnl-2011-301348
  6. Carvalheiro F, Rodrigues C, Adrego T, Viana J, Vieira H, Seco C, et al. Diastolic dysfunction in liver cirrhosis: prognostic predictor in liver transplantation? Transplant Proc 2016;48:128-131. https://doi.org/10.1016/j.transproceed.2016.01.010
  7. Ruiz-del-Arbol L, Serradilla R. Cirrhotic cardiomyopathy. World J Gastroenterol 2015;21:11502-11521. https://doi.org/10.3748/wjg.v21.i41.11502
  8. Fede G, Privitera G, Tomaselli T, Spadaro L, Purrello F. Cardiovascular dysfunction in patients with liver cirrhosis. Ann Gastroenterol 2015;28:31-40.
  9. Wiese S, Hove JD, Bendtsen F, Moller S. Cirrhotic cardiomyopathy: pathogenesis and clinical relevance. Nat Rev Gastroenterol Hepatol 2014;11:177-186. https://doi.org/10.1038/nrgastro.2013.210
  10. Falletta C, Fili D, Nugara C, Di Gesaro G, Mina C, Baravoglia CM, et al. Diastolic dysfunction diagnosed by tissue Doppler imaging in cirrhotic patients: prevalence and its possible relationship with clinical outcome. Eur J Intern Med 2015;26:830-834. https://doi.org/10.1016/j.ejim.2015.10.009
  11. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-133. https://doi.org/10.1016/j.echo.2008.11.023
  12. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016;29:277-314. https://doi.org/10.1016/j.echo.2016.01.011
  13. Moller S, Wiese S, Halgreen H, Hove JD. Diastolic dysfunction in cirrhosis. Heart Fail Rev 2016;21:599-610. https://doi.org/10.1007/s10741-016-9552-9
  14. Moller S, Henriksen JH. Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart 2002;87:9-15. https://doi.org/10.1136/heart.87.1.9
  15. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-649. https://doi.org/10.1002/bjs.1800600817
  16. Karagiannakis DS, Vlachogiannakos J, Anastasiadis G, Vafiadis-Zouboulis I, Ladas SD. Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis. Hepatol Int 2014;8:588-594. https://doi.org/10.1007/s12072-014-9544-6
  17. Kwon JH, Jang JW, Kim YW, Lee SW, Nam SW, Jaegal D, et al. The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis. BMC Gastroenterol 2015;15:146. https://doi.org/10.1186/s12876-015-0378-z
  18. Di Martino V, Coutris C, Cervoni JP, Dritsas S, Weil D, Richou C, et al. Prognostic value of C-reactive protein levels in patients with cirrhosis. Liver Transpl 2015;21:753-760. https://doi.org/10.1002/lt.24088
  19. Bernardi M, Calandra S, Colantoni A, Trevisani F, Raimondo ML, Sica G, et al. Q-T interval prolongation in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology 1998;27:28-34. https://doi.org/10.1002/hep.510270106
  20. Puthumana L, Chaudhry V, Thuluvath PJ. Prolonged QTc interval and its relationship to autonomic cardiovascular reflexes in patients with cirrhosis. J Hepatol 2001;35:733-738. https://doi.org/10.1016/S0168-8278(01)00217-3
  21. Bernardi M, Maggioli C, Dibra V, Zaccherini G. QT interval prolongation in liver cirrhosis: innocent bystander or serious threat? Expert Rev Gastroenterol Hepatol 2012;6:57-66. https://doi.org/10.1586/egh.11.86
  22. Henriksen JH, Gotze JP, Fuglsang S, Christensen E, Bendtsen F, Moller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut 2003;52:1511-1517. https://doi.org/10.1136/gut.52.10.1511
  23. Pimenta J, Paulo C, Gomes A, Silva S, Rocha-Goncalves F, Bettencourt P. B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis. Liver Int 2010;30:1059-1066.
  24. Shi LY, Jin R, Lin CJ, Wu JS, Chen XW, Yu Z, et al. B-type natriuretic peptide and cirrhosis progression. Genet Mol Res 2015;14:5188-5196. https://doi.org/10.4238/2015.May.18.9
  25. Ha JW, Oh JK. Therapeutic strategies for diastolic dysfunction: a clinical perspective. J Cardiovasc Ultrasound 2009;17:86-95. https://doi.org/10.4250/jcu.2009.17.3.86
  26. Ruiz-del-Arbol L, Achecar L, Serradilla R, Rodriguez-Gandia MA, Rivero M, Garrido E, et al. Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine. Hepatology 2013;58:1732-1741. https://doi.org/10.1002/hep.26509

Cited by

  1. Cirrhotic cardiomyopathy: An independent prognostic factor for cirrhotic patients vol.24, pp.4, 2018, https://doi.org/10.3350/cmh.2018.0098
  2. Syndecan-1: A Review on Its Role in Heart Failure and Chronic Liver Disease Patients’ Assessment vol.2019, pp.None, 2018, https://doi.org/10.1155/2019/4750580
  3. An update on cirrhotic cardiomyopathy vol.13, pp.5, 2019, https://doi.org/10.1080/17474124.2019.1587293
  4. Liver cirrhosis and left ventricle diastolic dysfunction: Systematic review vol.25, pp.32, 2019, https://doi.org/10.3748/wjg.v25.i32.4779
  5. Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice vol.37, pp.4, 2018, https://doi.org/10.1111/echo.14645
  6. Early echocardiographic signs of diastolic dysfunction predict acute kidney injury in cirrhotic patients vol.83, pp.11, 2018, https://doi.org/10.1097/jcma.0000000000000422
  7. Interplay of cardiovascular mediators, oxidative stress and inflammation in liver disease and its complications vol.18, pp.2, 2021, https://doi.org/10.1038/s41569-020-0433-5
  8. Diastolic Dysfunction Is a Predictor of Poor Survival in Patients with Decompensated Cirrhosis vol.2021, pp.None, 2018, https://doi.org/10.1155/2021/5592376
  9. The prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria vol.41, pp.5, 2018, https://doi.org/10.1111/liv.14769
  10. Direct Bilirubin Is More Valuable than Total Bilirubin for Predicting Prognosis in Patients with Liver Cirrhosis vol.15, pp.4, 2018, https://doi.org/10.5009/gnl20171