Article Sidebar

Download
Requires Subscription PDF
Statistic
Read Counter : 222 Download : 4

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Main Article Content

Abstract

BACKGROUND


The presence of cardiovascular dysfunction in liver cirrhosis has been studied over the past several years. Cardiovascular dysfunctions in cirrhosis increase the risk of coronary artery disease and mortality after TIPSS insertion and liver transplantation. Cirrhotic cardiomyopathy also plays an important role in the pathogenesis of hepatorenal syndrome. All these data highlight the need for rigorous cardiovascular risk assessment in patients with liver cirrhosis.


METHODS


After obtaining institutional approval, we analysed 96 consenting patients with liver cirrhosis satisfying inclusion criteria. Relevant history of the cases was sought through a structured questionnaire. Appropriate clinical examinations were done. Echocardiogram, ECG and biochemical parameters of the patients were examined and recorded. Data analysis was done using SPSS software.


RESULTS


51% of the patients had QTc > 0.44 seconds in ECG which was suggestive of electrophysiological abnormality. The systolic dysfunction was assessed by presence of left ventricular ejection fraction below 55%, which was detected in 4.2% of the patients. E/A ratio less than 1 and deceleration time more than 200 msec were taken as parameters suggestive of the presence of diastolic dysfunction. 34.4% had an E/A ratio < 1 and 42.7% of the patients had a deceleration time more than 200 msec. 53% were found to have cirrhotic cardiomyopathy. The prevalence of CCM was increasing with the severity of liver disease. 53.1% of the patients had left ventricular hypertrophy and there was significant association between the prevalence of LVH and severity of cirrhosis. 38.5% of the patients had coronary artery disease as per history and ECG findings. No significant association was obtained between the prevalence of CAD and severity of CLD. 4.2% patients had arrhythmia and there was a significant association with the severity of disease. Troponin I was elevated in 20.8% of the patients.


CONCLUSIONS


Liver cirrhosis is a risk factor for cardiovascular dysfunctions. Most of the patients with cardiac compromise were asymptomatic. 53% patients were diagnosed to have cirrhotic cardiomyopathy. The prevalence of cardiovascular dysfunctions was found to increase with the rising severity of cirrhosis as per CTP score. Diastolic dysfunction was more prevalent than systolic dysfunction. The prevalence of cardiovascular dysfunctions was lesser among patients with regular follow-up and treatment for cirrhosis liver. 38.5% of the patients had coronary artery disease. The prevalence of arrhythmias was 4.2%. Troponin levels were elevated in 20.8% patients.

Keywords

CLD – Chronic Liver Disease; CCM- Cirrhotic Cardiomyopathy; CAD – Coronary Artery Disease; LT- Liver Transplantation; MELD – Model for End Stage Liver Disease; TIPS – Transjugular Intrahepatic Portosystemic Shunt; CTP Score – Child Turcott Pugh Score; LVH – Left Ventricular Hypertrophy.

Article Details

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite
Kasthuri Ramachandran Pillai, Selvarajan Chettiar K. P., & Suresh M. K. (2023). Assessment of Cardiac Dysfunctions in Patients with Liver Cirrhosis Admitted in a Tertiary Care Centre. Journal of Evolution of Medical and Dental Sciences, 12(11), 331–335. https://doi.org/10.14260/jemds.v12i11.515
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
Crossref
Scopus
Google Scholar
Europe PMC

References

  1. Moller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol 2010;53(1):179-90.
  2. Lee SS, Marty J, Mantz J, et al. Desensitization of myocardial beta-adrenergic receptors in cirrhotic rats. Hepatology 1990;12(3):481-5.
  3. Ma Z, Lee SS, Meddings JB. Effects of altered cardiac membrane fluidity on beta-adrenergic receptor signalling in rats with cirrhotic cardiomyopathy. J Hepatol 1997;26(4):904-12.
  4. Ma Z, Meddings JB, Lee SS. Membrane physical properties determine cardiac beta-adrenergic receptor function in cirrhotic rats. Am J Physiol 1994;267(1):G87-93.
  5. Gaskari SA, Liu H, Moezi L, et al. Role of endocannabinoids in the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats. Br J Pharmacol 2005;146(3):315-23.
  6. Grose RD, Nolan J, Dillon JF, et al. Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis. J Hepatol 1995;22(3):326-32.
  7. Kelbaek H, Eriksen J, Brynjolf I, et al. Cardiac performance in patients with asymptomatic alcoholic cirrhosis of the liver. Am J Cardiol 1984;54(7):852-5.
  8. Kelbaek H, Rabol A, Brynjolf I, et al. Haemodynamic response to exercise in patients with alcoholic liver cirrhosis. Clin Physiol 1987;7(1):35-41.
  9. Moller S, Henriksen JH. Cardiovascular complications of cirrhosis. Gut 2008;57:268-78.
  10. Beyer N, Aadahl M, Strange B, et al. Improved physical performance after orthotopic liver transplantation. Liver Transpl Surg 1999;5(4):301-9.
  11. Moller S, Wiinberg N, Hernriksen JH. Noninvasive 24-hour ambulatory arterial blood pressure monitoring in cirrhosis. Hepatology 1995;22(1):88-95.
  12. Silver MA, Maisel A, Yancy CW, et al. BNP Consensus Panel 2004: a clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases. Congest Heart Fail 2004;10(5 Suppl 3).
  13. Krag A, Hobolth L, Moller S, et al. Hyponatraemia during terlipressin therapy. Gut 2010;59(3):417-8.
  14. Rodriguez-Laiz JM, Banares R, Echenagusia A, et al. Effects of transjugular intrahepatic portasystemic shunt (TIPS) on splanchnic and systemic hemodynamics, and hepatic function in patients with portal hypertension. Preliminary results. Dig Dis Sci 1995;40:2121-7.
  15. Merli M, Valeriano V, Funaro S, et al. Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS). Am J Gastroenterol 2002;97(1):142–8.
  16. Ingles AC, Hernandez I, Garcia-Estan J, et al. Limited cardiac preload reserve in conscious cirrhotic rats. Am J Physiol 1991;260(6):H1912-7.
  17. Plotkin JS, Scott VL, Pinna A, et al. Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation. Liver Transpl Surg 1996;2(6):426-30.
  18. Murray KF, Carithers RL. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology 2005;41(6):1407-32.
  19. Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation 2012;126(5):617-63.
  20. Huo TI, Wu JC, Lin HC, et al. Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. J Hepatol 2005;42(6):826-32.
  21. Stundiene I, Sarnelyte J, Norkute A, et al. Liver cirrhosis and left ventricle diastolic dysfunction: Systematic review; World J Gastroenterol 2019;25(32): 4779-95.
  22. De Marco M, Chinali M, Romano C, et al. Increased left ventricular mass in pre-liver transplantation cirrhotic patients. J Cardiovasc Med (Hagerstown) 2008;9(2):142-6.
  23. Kalaitzakis E, Rosengren A, Skommevik T, Björnsson E. Coronary artery disease in patients with liver cirrhosis. Digestive Diseases and Sciences 2010;55:467-75.