title: Frequency and severity of cirrhotic cardiomyopathy and its possible relationship with bacterial endotoxemia.
abstract: BACKGROUND
  The cardiac dysfunction presented in cirrhotic patients is already known as cirrhotic cardiomyopathy. The pathogenesis of this entity is not fully understood.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the frequency and characteristics of cirrhotic cardiomyopathy and to investigate the possible role of bacterial endotoxemia on its aggravation.
  
  
  METHODS
  Forty-five cirrhotics were studied by a tissue Doppler imaging echocardiography at rest and after stress. The diagnosis of left ventricular diastolic dysfunction was based on the latest guidelines of the American Society of Echocardiography, whereas its severity was defined by the E/e'av ratio. Endotoxemia was estimated by measuring the serum levels of lipopolysaccharide-binding protein (LBP) and cytokines.
  
  
  RESULTS
  None of the patients had systolic dysfunction, but 17/45 (37.8 %) had a diastolic one. Patients with grade II diastolic dysfunction had significantly longer QTc (p = 0.049), larger left atrium volume (p = 0.013), higher Brain Natriuretic Peptide levels (p = 0.007) and higher LBP levels (p = 0.02), compared to those with normal cardiac function, without differences in the systemic hemodynamics and the cytokines' levels. Moreover, the severity of diastolic dysfunction as reflected by the E/e'av. was significantly correlated with the LBP levels (p = 0.002). On the multivariate analysis, the LBP was independently associated with the presence of diastolic dysfunction.
  
  
  CONCLUSIONS
  Cirrhosis is commonly complicated by cardiac dysfunction. Patients with severe cirrhotic cardiomyopathy have higher LBP levels, which are significantly correlated with the degree of diastolic dysfunction. Our findings support a potential role of bacterial endotoxemia on the aggravation of cardiomyopathy in cirrhotic patients.
authors.affiliation: Hepatogastroenterology Unit, 1st Department of Medicine Propaedeutic, Medical School of Athens, Laikon General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece, d_karagiannakis@hotmail.com.
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Karagiannakis
authors.forename: Jiannis
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Georgios
authors.initials: G
authors.lastname: Anastasiadis
authors.forename: Irini
authors.initials: I
authors.lastname: Vafiadis-Zouboulis
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
mesh_terms: D000209:Acute-Phase Proteins; D000368:Aged; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D002352:Carrier Proteins / Q000097:blood; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D015150:Echocardiography, Doppler; D019446:Endotoxemia / Q000150:complications* / Q000382:microbiology*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002352:Carrier Proteins; D016207:Cytokines; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein
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