title: Cardiac dysfunction in cirrhotic portal hypertension with or without ascites.
abstract: BACKGROUND
  Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it correlates with severity of hepatic failure. But cardiac functions by conventional 2-dimensional (2-D) echocardiography has limitations. The aim of the study was to evaluate cardiac systolic and diastolic functions in liver cirrhosis patients with or without ascites by tissue Doppler imaging and conventional 2-D- echocardiography.
  
  
  METHODS
  A cross sectional case control study of sixty patients. Twenty subjects grouped as healthy controls, pre-ascitic cirrhosis and cirrhosis with ascites were enrolled. Cardiac evaluation was done by both conventional Doppler and tissue Doppler echocardiography.
  
  
  RESULTS
  Cirrhosis with portal hypertension is associated with increased heart rate, ejection fraction and mean peak systolic velocity, while mean arterial pressure is decreased. All cardiac chamber dilation occurs and is mostly seen in the left atrium. Ratio of early diastolic annular velocity to peak early diastolic annular wave velocity (E/e') was the most significant marker for diastolic dysfunction. E/e' ratio was 7.76±0.40, 12.55±1.73 and 11.4±1.19 in healthy controls, pre ascitic cirrhosis and ascitic cirrhosis respectively (P<0.0001). Overall Type I and II Left ventricular diastolic dysfunction was present in 70% cirrhotic patient with or without ascites, while there were no cases of Type III (Severe) diastolic dysfunction.
  
  
  CONCLUSIONS
  Left ventricular diastolic dysfunction is commonly associated with advancement of hepatic dysfunction while systolic function is maintained till advanced hepatic failure. Peak early diastolic wave velocity, deceleration time and E/e' ratio for left ventricular diastolic dysfunction are accurately assessed by pulsed tissue Doppler imaging.
authors: Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur.
authors: Sunil
authors: S
authors: Dadhich
authors: Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur.
authors: Amitava
authors: A
authors: Goswami
authors: Department of Cardiology (Vinit Kumar Jain), Dr Sampurnanand Medical College, Jodhpur.
authors: Vinit Kumar
authors: VK
authors: Jain
authors: Department of Medicine (Ankur Gahlot), Dr Sampurnanand Medical College, Jodhpur.
authors: Ankur
authors: A
authors: Gahlot
authors: Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur.
authors: Ganaraj
authors: G
authors: Kulamarva
authors: Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur.
authors: Narendra
authors: N
authors: Bhargava
keywords: Tissue Doppler imaging; early diastolic velocity; late diastolic velocity; peak early diastolic wave velocity; peak systolic velocity