Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with Child-Pugh A and B cirrhosis: A case-control study

Poojary, M Swathi; Samanth, Jyothi; Nayak, Krishnananda; Shetty, Shiran; Nayak, Shivananda; Rao, M. Sudhakar

doi:10.1007/s12664-022-01277-w

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…These findings could be attributed to the presence of hyperdynamic circulation and the higher LV contractility which are more prominent in patients with greater liver dysfunction. Similarly to our study, five previous studies 9,10,13,26,27 supported our findings ( Table 6 ) . On the contrary, other studies did not find any association between GLS and severity of cirrhosis, 12,28–35 while three studies found opposite results 11,36,37 .…”

Section: Discussionsupporting

confidence: 92%

Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium

Skouloudi,

Bonou,

Adamantou

et al. 2023

Liver International

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BackgroundThe new criteria of Cirrhotic Cardiomyopathy Consortium (CCC) propose the use of left ventricular global longitudinal strain (LV‐GLS) for evaluation of systolic function in patients with cirrhosis. The aim of this study was to evaluate LV‐GLS and left atrial (LA) strain in association with the severity of liver disease and to assess the characteristics of cirrhotic cardiomyopathy (CCM).MethodsOne hundred and thirty‐five cirrhotic patients were included. Standard echocardiography and speckle tracking echocardiography (2D‐STE) were performed, and dual X‐ray absorptiometry was used to quantify the total and regional fat mass. CCM was defined, based on the criteria of CCC, as having advanced diastolic dysfunction, left ventricular ejection fraction ≤50% and/or a GLS <18%.ResultsLV‐GLS lower or higher than the absolute mean value (22.7%) was not associated with mortality (logrank, p = 0.96). LV‐GLS was higher in patients with Model for end stage liver disease (MELD) score ≥15 compared to MELD score <15 (p = 0.004). MELD score was the only factor independently associated with systolic function (LV‐GLS <22.7% vs. ≥22.7%) (Odds Ratio:1.141, p = 0.032). Patients with CCM (n = 11) had higher values of estimated volume of visceral adipose tissue compared with patients without CCM (median: 735 vs. 641 cm3, p = 0.039). On multivariable Cox regression analysis, MELD score [Hazard Ratio (HR):1.26, p < 0.001] and LA reservoir strain (HR:0.96, p = 0.017) were the only factors independently associated with the outcome.ConclusionIn our study, absolute LV‐GLS was higher in more severe liver disease, and LA reservoir strain was significantly associated with the outcome in patients with end‐stage liver disease.

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Section: Discussionsupporting

confidence: 92%

Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium

Skouloudi,

Bonou,

Adamantou

et al. 2023

Liver International

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“…Studies published later, when guidelines for GLS measurement were more standardized, yielded varying results. Most studies did not find statistically significant differences between patients and controls [38,40,41], while some studies found lower absolute values for patients with cirrhosis than for controls [37,42]. Some studies even found increased GLS values in cirrhotic patients compared to controls.…”

Section: How Different Are Left Ventricular Strain Values Of Cirrhoti...mentioning

confidence: 99%

The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy

Dimitroglou,

Aggeli,

Alexopoulou

et al. 2024

Life

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Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association—in the majority of studies—with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis.

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Editorial commentary on the Indian Journal of Gastroenterology—November–December 2022

Limdi

2022

Indian J Gastroenterol

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Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with Child-Pugh A and B cirrhosis: A case-control study

Cited by 4 publications

References 17 publications

Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium

Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium

The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy

Editorial commentary on the Indian Journal of Gastroenterology—November–December 2022

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