Diastolic Dysfunction in Liver Cirrhosis: Prognostic Predictor in Liver Transplantation?

Abstract

Background. Patients with liver cirrhosis may develop cirrhotic cardiomyopathy (CC), characterized by blunted contractile responsiveness to stress, diastolic dysfunction (DD), and electrophysiological abnormalities. It may adversely affect the long-term prognosis of these patients. Methods. We conducted a retrospective analysis of patients undergoing liver transplantation (LT) for cirrhosis from January 2012 to June 2015. We analyzed demographic characteristics, the etiology of cirrhosis, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, the corrected QT (QTc) interval in the preoperative period, diastolic and systolic dysfunction, mortality and survival, and duration of mechanical ventilation and vasopressor support in the post-LT period. These variables were compared with diastolic dysfunction and prolongation of QTc, with the use of chisquare, Fisher, and Mann-Whitney U tests. Results. The study included 106 patients, 80.2% male and overall average age 54.83 years. The median MELD score was 16, and Child-Pugh class C in 55.4%. Prolonged QTc interval before LT was present in 19% and DD in 35.8% of patients. QTc before LT or DD did not vary significantly with MELD or Child-Pugh score. Conclusions. The patients in the pre-LT period presented with a significant incidence of DD, which can predispose them to adverse cardiac events. The presence of DD correlates with mortality after LT in patients with hepatic cirrhosis.

Cirrhotic cardiomyopathy: we already know. What comes next?

“…It is defined by one or more of the following: structural abnormalities in cardiac chambers; diastolic dysfunction; normal or augmented systolic function at rest but poor contractile response to stress; and electrophysiological changes [2]. These abnormalities may be observed in up to 50% of cirrhotic patients [3].…”

“…Electrocardiographic (ECG) abnormalities can be early noticed in a asymptomatic CCM patient and may correlate with ventricular arrhythmias and sudden death [3]. The most common ECG finding is QT interval prolongation, which may be observed in approximately 30-40% of cirrhotic patients, mainly Child-Pugh B or C, regardless cirrhosis etiology [19,16].…”

“…Recent studies with global longitudinal strain (GLS) evaluation shows that this may be a helpful method for the early detection of cardiac dysfunction in the cirrhotic patient, mainly the systolic dysfunction at rest [3,28]. E/A ratio may be a reliable parameter in the diagnosis of diastolic dysfunction in cirrhotic patients, even with values influenced by the degree of hydration of the patient, although it may vary due to ascites…”

“…Cirrhotic cardiomyopathy (CCM) is a cardiac dysfunction characterized by suboptimal contractile response to stress and impaired diastolic function in the absence of previous cardiac disease [1][2][3]. Nowadays, research has proposed that cirrhotic patients have an intrinsic cardiac dysfunction that may influence in the development of renal failure in advanced liver disease [4].…”

“…However, there's still a gap of knowledge regarding management of this condition [6]. The presence of myocardial dysfunction in cirrhosis increases the risk of hepatorrenal syndrome (HRS) and adverse cardiac events and it is related to higher mortality [3].…”