title: Cardiac alterations in cirrhosis: reversibility after liver transplantation.
abstract: OBJECTIVE
  Liver cirrhosis induces cardiac alterations. We aimed to define these alterations and assess their reversibility after transplantation.
  
  
  METHODS
  Cirrhotic patients (n = 40) and controls (n = 15) underwent echocardiography and stress ventriculography. Fifteen cirrhotics were reevaluated 6-12 months after transplantation.
  
  
  RESULTS
  Cirrhotics had higher left ventricular wall thickness (9.6+/-1.2 vs. 8.8+/-1.2 mm; P < 0.05) and ejection fraction (73+/-6 vs. 65+/-4%, P < 0.001) than controls. Basal diastolic function was similar. During stress, cirrhotics presented lower increases of heart rate, left ventricular ejection fraction, stroke volume and cardiac index (P < 0.05 for all), and diastolic dysfunction with lower ventricular peak filling rate (P = 0.001). Exercise capacity was reduced (48+/-21 vs. 76+/-24 W; P < 0.001). Ascitic patients exhibited more diastolic dysfunction at rest and during stress compared to non-ascitic patients. Liver transplantation caused regression of ventricular wall thickness (10.2+/-1.3 vs. 9.5+/-1.2 mm; P < 0.05), improvement of diastolic function, and normalization of systolic response and exercise capacity during stress (significant increases in heart rate, ventricular ejection fraction, stroke volume and cardiac index; P < 0.05 for all).
  
  
  CONCLUSIONS
  Cardiac alterations in cirrhosis present with mild increases in ventricular wall thickness, diastolic dysfunction that worsens with ascites and physical stress, and abnormal systolic response to stress limiting exercise capacity. Liver transplantation reverses these alterations.
authors.affiliation: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Passeig Vall d'Hebron 119, Barcelona 08035, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Torregrosa
authors.forename: Santi
authors.initials: S
authors.lastname: Aguadé
authors.forename: Laura
authors.initials: L
authors.lastname: Dos
authors.forename: Rosa
authors.initials: R
authors.lastname: Segura
authors.forename: Antonio
authors.initials: A
authors.lastname: Gónzalez
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista
authors.forename: Joan
authors.initials: J
authors.lastname: Castell
authors.forename: Carlos
authors.initials: C
authors.lastname: Margarit
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
authors.forename: Jaume
authors.initials: J
authors.lastname: Guardia
authors.forename: Joan
authors.initials: J
authors.lastname: Genescà
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D013599:Systole; D016277:Ventricular Function, Left