title: Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis.
abstract: OBJECTIVE
  Left ventricular diastolic dysfunction (LVDD) constitutes the prominent characteristic of cirrhotic cardiomyopathy, but its relevance on the clinical course of cirrhotic patients has not been clearly defined. The aim of the study was to evaluate the relationship of LVDD with the severity and etiology of liver disease and to investigate whether it affects the outcome of cirrhotic patients.
  
  
  METHODS
  Cardiac function of 45 cirrhotics was studied by a tissue Doppler imaging echocardiography. Diagnosis of LVDD was made according to the latest guidelines of the American Society of Echocardiography. All patients were followed up for a period of 2 years. Death or liver transplantation was the endpoint of the study.
  
  
  RESULTS
  LVDD was found in 17 (38 %) of 45 patients. Its presence was not found to be associated with the etiology and stage of cirrhosis, but its severity was directly correlated with the Child-Pugh score. At the end of follow-up, 14 patients had died; 9 had LVDD (9/17, 53 %) and 5 had not (5/28, 18 %). Patients who died at the beginning of observation period had a higher Child-Pugh and MELD score, higher BNP, lower albumin and more prolonged QTc. On Kaplan-Meier analysis, patients with LVDD had statistically significantly worse prognosis compared to those without (p = 0.013, log rank: 5.495). Low albumin values (p = 0.003) and presence of LVDD (p = 0.017) were independent predictive factors of mortality.
  
  
  CONCLUSIONS
  LVDD is a common complication of cirrhosis. As its development seems to be related to a worse prognosis, patients with LVDD must be under a strict follow-up.
authors.affiliation: Academic Department of Gastroenterology, Medical School of Athens, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece. d_karagiannakis@hotmail.com.
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Karagiannakis
authors.affiliation: Academic Department of Gastroenterology, Medical School of Athens, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece. jvlachog@hotmail.com.
authors.forename: Jiannis
authors.initials: J
authors.lastname: Vlachogiannakos
authors.affiliation: Department of Cardiology, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece. fayk@otenet.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Anastasiadis
authors.affiliation: Academic Department of Gastroenterology, Medical School of Athens, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece. izoubvaf@med.uoa.gr.
authors.forename: Irini
authors.initials: I
authors.lastname: Vafiadis-Zouboulis
authors.affiliation: Academic Department of Gastroenterology, Medical School of Athens, Laikon General Hospital, 17 Aghiou Thoma Street, 11527, Athens, Greece. sdladas@otenet.gr.
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
keywords: Cardiomyopathy; Cirrhosis; Diastolic dysfunction; Survival