Cardiac dysfunction in patients with cirrhosis: is the systolic component its main feature?
OBJECTIVE
To investigate the subclinical cardiac morphological and functional modifications in cirrhotic patients according to the stage of liver disease.


METHODS
One hundred and thirteen cirrhotic patients underwent standard Doppler echocardiography and were compared with healthy individuals. Left ventricular (LV) geometry, systolic/diastolic function, and the main hemodynamic parameters were assessed according to current guidelines.


RESULTS
Cirrhotic patients showed a reduction in the peripheral vascular resistance (PVR), a compensatory hyperdynamic syndrome, and a significant increase in cardiac index (CI), cardiac output (CO), and cardiac work, with a consequent increase in the prevalence of LV hypertrophy and associated diastolic dysfunction (DD). Age (P=0.005) and LV mass index (P=0.03) were the strongest predictors of DD. Even though all the systolic parameters assessed were similar between patients and controls, in patients with refractory ascites, the reduction of the PVR and mean blood pressure was not balanced by a further increase in cardiac work and therefore the CI and CO were supported only by the increase in heart rate.


CONCLUSIONS
In cirrhotic patients, DD is strongly related to the increase in LV mass, not related to the stage of the liver disease, and can be correctly detectable only by the use of tissue Doppler imaging. For systolic dysfunction, along with the development and worsening of ascites, CO and CI do not increase further to compensate the continuous reduction of PVR and mean blood pressure, and their maintenance becomes critically dependent on the heart rate, thus suggesting a possible detrimental effect of β-blockers in these patients.
aUnit of Hepatic Emergencies and Liver Transplantation, Department of Surgery bDepartment of Medicine, University of Padova, Padova, Italy.
Maurizio
M
Cesari
Silvano
S
Fasolato
Silvia
S
Rosi
Paolo
P
Angeli
D000368:Aged; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*