title: Myocardial late gadolinium enhancement cardiovascular magnetic resonance in patients with cirrhosis.
abstract: BACKGROUND
  Portal hypertension and cardiac alterations previously described as "cirrhotic cardiomyopathy" are known complications of end stage liver disease (ELD). Cardiac failure contributes to morbidity and mortality, particularly after liver transplantation and transjugular intrahepatic portosystemic shunt (TIPS). We sought to identify myocardial tissue characterization and evaluate cardiovascular magnetic resonance (CMR) for diagnosis of cardiac impairment.
  
  
  RESULTS
  Twenty ELD patients underwent CMR for morphological, functional and tissue characterization by late gadolinium enhancement (LGE). Based on extent of LGE, patients were dichotomized into high and low LGE groups and analyzed regarding liver, cardiocirculatory and renal functions. CMR demonstrated hyperdynamic left ventricular function and a patchy pattern of LGE of the myocardium to a variable extent (range 2-62%) in all patients. There were no significant differences in Model for End-Stage Liver Disease (MELD), Child-Pugh score or the left ventricular ejection fraction between high and low LGE groups. QTc-interval was prolonged in 25% of the patients. E/A ratio was at the upper limit of norm; no difference between groups. Patients showing high LGE had a higher CI (p < 0.05). Biomarkers of myocardial stress were elevated. While NT-proBNP and c-Troponin-T showed no differences, PLGF and sFLT1 were lower in the high LGE group.
  
  
  CONCLUSIONS
  CMR shows myocardial involvement in patients with ELD resembling appearance of myocarditis. The hyperdynamic circulation in portal hypertension may be an important factor. Larger prospective trials are warranted to confirm the association with severity and outcome of liver disease and to test the predictive power of CMR for patients listed for liver transplantation.
authors: Department of Internal Medicine III, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
authors: Dirk
authors: D
authors: Lossnitzer
authors: Henning
authors: H
authors: Steen
authors: Alexandra
authors: A
authors: Zahn
authors: Stephanie
authors: S
authors: Lehrke
authors: Celine
authors: C
authors: Weiss
authors: Karl Heinz
authors: KH
authors: Weiss
authors: Evangelos
authors: E
authors: Giannitsis
authors: Wolfgang
authors: W
authors: Stremmel
authors: Peter
authors: P
authors: Sauer
authors: Hugo A
authors: HA
authors: Katus
authors: Daniel N
authors: DN
authors: Gotthardt
mesh_terms: D005260:Female; D005355:Fibrosis / Q000150:complications; D005682:Gadolinium; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009206:Myocardium / Q000473:pathology*
chemical_list: D005682:Gadolinium