Systolic dysfunction and diastolic dysfunction do not influence medium-term prognosis in patients with cirrhosis.
OBJECTIVE
Myocardial dysfunction has been described in patients with cirrhosis and may contribute to haemodynamic disturbances in advanced disease states. However, the prognostic impact of cardiac systolic and diastolic dysfunction in cirrhosis is controversial. We aimed to evaluate the performance of echocardiographic parameters of cardiac function as medium-term prognostic markers, in a cohort of cirrhotic patients.


METHODS
Ninety-eight patients (52 discharged after hospitalization for decompensated cirrhosis and 46 ambulatory) were prospectively evaluated. A comprehensive echocardiographic study, including tissue-Doppler and speckle tracking analysis, was performed at baseline. Patients were followed-up for 6 months for the occurrence of death.


RESULTS
Twenty patients died during the follow-up. None of the echocardiographic parameters were associated with the occurrence of death. A Child score>10 points (HR 13.1, 95% CI 3.79-45.0, p<0.001) and a mean arterial pressure below the median (HR 3.2, 95% CI 1.14-8.80, p=0.028) were the only independent predictors of mortality in Cox regression multivariate analysis. In previously hospitalized patients, cardiac output, C-reactive protein and albumin levels were associated with 6-month mortality in univariate analysis; this association was lost after adjusting for Child score.


CONCLUSIONS
Medium-term mortality in cirrhosis seems to be mainly determined by liver disease severity rather than by myocardial dysfunction. Modern echocardiographic indices of systolic and diastolic function do not seem to be useful in identifying patients at increased risk of dying.
Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal; University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: fpasampaio@gmail.com.
Francisco
F
Sampaio
University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: joanamartinspimenta@gmail.com.
Joana
J
Pimenta
Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal; University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: bettencourt.n@gmail.com.
Nuno
N
Bettencourt
Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal; University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: fontes.carvalho@gmail.com.
Ricardo
R
Fontes-Carvalho
Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: anapaulasilva1@gmail.com.
Ana-Paula
AP
Silva
Internal Medicine Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: jfpvalente@gmail.com.
João
J
Valente
University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: pbettfer@med.up.pt.
Paulo
P
Bettencourt
Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: jfraga@chvng.min-saude.pt.
José
J
Fraga
Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: ribeiro.vasco@gmail.com.
Vasco
V
Gama
D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013599:Systole
Cardiac function; Cirrhosis; Echocardiography; Prognosis