title: Cirrhotic cardiomyopathy: does it contribute to chronic fatigue and decreased health-related quality of life in cirrhosis?
abstract: Diminished health-related quality of life (HRQoL) and fatigue have been reported in patients with cirrhosis. The presence of cirrhotic cardiomyopathy and the attendant poor cardiac response to physical stress may affect HRQoL and contribute to fatigue in these patients.
  
  
  OBJECTIVE
  To evaluate the contribution of cirrhotic cardiomyopathy to HRQoL and fatigue in ambulatory cirrhotic patients.
  
  
  METHODS
  Thirty ambulatory cirrhotic patients (14 preascitic, Child-Pugh score 5.6 +/- 0.3; 16 ascitic, Child-Pugh score 9.1 +/- 0.5) underwent cardiopulmonary exercise testing and assessment of HRQoL, fatigue and depressive symptomatology. HRQoL and fatigue scores were correlated with liver disease severity, depressive symptomatology and parameters of cardiac function and exercise physiology.
  
  
  RESULTS
  Subscales of all HRQoL measuring the effect of disease on the ability to perform physical, social and emotional roles were significantly impaired when compared with controls (P<0.001). The impact of fatigue, as assessed by the Fatigue Assessment Inventory, was greater in cirrhotics (4.46 versus 2.53 in healthy age-matched controls, P<0.01). Diminished HRQoL, impact of fatigue and vitality were related to depressive symptoms rather than to cardiac structural and functional abnormalities, which were present in cirrhotic patients. Poorer physical quality of life scores correlated with diminished mental health.
  
  
  CONCLUSIONS
  Depression, rather than the presence of cirrhotic cardiomyopathy, may have contributed to the diminished HRQoL and vitality in patients with cirrhosis with or without ascites.
authors.affiliation: Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Nigel
authors.initials: N
authors.lastname: Girgrah
authors.forename: Graham
authors.initials: G
authors.lastname: Reid
authors.forename: Shona
authors.initials: S
authors.lastname: MacKenzie
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology*; D003863:Depression / Q000523:psychology; D004452:Echocardiography; D005080:Exercise Test; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000209:etiology / Q000523:psychology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011875:Radionuclide Angiography